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ANNTiAi. FF.F, and REPORT RF.OTiF.ST <br />RECEIVED <br />PERMITTEE NAME: George E. Otten APR 212003 <br />PERMIT NO.: M-1984-013 Oi~ision pf Minerals and Geplpg~ <br />OPERATION NAME: Mackey Mine <br />ANNIVERSARY DATE: May 14, 2003 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Gilpin <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 shall submit the annua ee, a report an map s owing e ex"ten~o~current disturbarrces-to-affected-- <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 />pJgase attach ym~r revised written annnal re~prt and annnal rennrt m~tn 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. <br />changes: <br />Permittee Contact: George E. Otten <br />Permittee Name: George E. Otten <br />Address: 11438 CR 19 <br />Fort Lupton, CO 80621 <br />Phone Number: (970) 785-2538 <br />Fax Number: <br />Ple~as/eJ/vferify and make any necessary <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 are <br />enclosed. <br />Officer, Owner, or Designee <br />M:~PERMITMASTERDOCUMENTS/M-AP-02.DOC <br />