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<br />ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br />PERMITTEE NAME: John O Buckner <br />PERMIT NO.: M-1993-030 APR 2 2 2002 <br />OPERATION NAME: Crystaljack Mine Division of Mineral <br /> s and Geology <br />ANNNERSARY DATE: Apri126, 2002 <br />ANNUAL FEE DUE: $75.00 (Due on or before your anniversary date) <br />COUNTY: Teller <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversazy date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />-'-~1and; 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 [he date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice fora written <br />report. <br />Division records indicate the following pemuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John O. Buckner <br />Permittee Name: John O Buckner <br />Address: 2516 Waldean St. <br />Colorado Springs, CO 80909-4015 <br />Phone Number: (719) 634-4042 <br />Fax Number: ~ (719) 634-543 ] <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 or Owner <br />M:~PERMI]~MASTERDOCUMENTS/M-AF-02. DOC <br />`. ~ori~ /~' ~ On? <br />Date ~ ~ <br />