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t ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />1 `/ <br />ANNUAL FEE and REPORT REQUEST <br />Mineral County <br />M-1984-097 <br />Mineral County Pit <br />June 28, 2002 <br />R~CEI VED <br />JUL ~ 2 ~ <br />Derision at Minerals and 6ealogY <br />$688.00 (Due on or before your anniversary date) <br />Mineral <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 />-._operator~hall_submit-the_annual_fee,_a_report~nd-map_showing_the~xtent of current.distucbances to-affected _ - _ <br />land, reclamation accomplished to date and during [he 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 your revised written annual reuort and annual reuort maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Leslie Cahill <br />Permittee Name: Mineral County <br />Address: P.O. Box 70 <br />Creede, CO 81130 <br />.~_ Phone Number: (719) 658-2360 <br />Fax Number: (719) 658-2931 <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Sign ure of Corporate Officer °r Owner <br />aQ ~ 00 ~ <br />D e <br />M:~PERMIT~MASTERDOCUMENTSVN-AF-04 <br />