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bv~ ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Gail C. Allen and Millie J. Allen <br />r/ M-2000-OSO <br />Broken Spear Pit <br />October 2, 2006 <br />RECEI~/ED <br />DEC 19 2006 <br />~ivision of Reclamation, <br />Mining end Safety <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <br />rvl <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual renort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary. then no new map is required. arovided that the Oaerator shall state <br />this in the Annual Report. Please note that an adequately Zabeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Bain <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Gail C. Allen and Millie J. Allen <br />30011 County Highway 109 <br />Hugo, CO 80821 <br />~ ~o x 3 <br />(719) 740-0156 //'~ <br />(~- (7 / 9~ S`/y- 3 3S~ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions aze enclosed. <br />/Uo ii e~J i~~~oy ~ Yly~ ~L.~- <br />p'_ <br />Signature of Corporate Ots ~cer, Owner, or Designee <br />is-/o ~ <br />Date <br />