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uJ~~°.. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V ANNUAL FEE and REPORT REQUEST <br />'~ Lance and Bob Barker <br />M-1977-417 <br />Sego Mine <br />November 1, 2006 <br />i'C~- ~f°~°a@ 4f-; <br />J <br />/~'~OV ~22OOTOn, <br />a/ ~iininy 4nu safety <br />$225.00 (Due on or before your anniversary date) <br />San Miguel <br />~~~~ <br />,~~~~oi6 <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 <br />n P,~r„r ~t,~n ~„t,miitheannual-fee.-a-resort-end-man-sliewinc-the erHent-o€current-disturbanccs-to-affccte~---- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form, The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary. then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Lance Barker <br />Permittee Name: Lance and Bob Barker <br />Address: P.O. Box 821 <br />Lake City, CO 81235 <br />Phone Number: (970) 944-0155 <br />Fax Number: (970) 944-0199 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below off~~attach it to this form along with your written report and map. Annual Report instructions are <br />Signathre of Corpol`afe Officer, Owner, or Designee <br />ID~~O~~~ <br />Date T <br />M:~PERMITMASTERDOCUMENT&hf-AF-02.DOC <br />