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~~ III IIII IIIIIIII III <br />ANNUAL REPORT <br />PERMITTEE NAME: Dolores County ~=CEIVED <br />PERMIT NO.: M-95-010 FED 19 X999 <br />OPERATION NAME: Black Snag* <br />~_„ ~~ ,~,nerals & Geob01B <br />ANNIVERSARY DATE: March 24, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Dolores <br />~~ >- <br />/~ <br />~` <br />Ln order to ensure that our records are uo to date, please attach your revised annual report m.ap and written <br />report to this annual report. Note that a written report is not necessary if the map addresses all the <br />items listed in the attached instructions concerning mining disturbance and reclamation update. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: /~ it~l ~~/i S ~~r V Company: ~ n~ o t'c 5 `o ce n ~,/ <br /> <br />Address:: (~, f~ , c, ~ CS ~ Phone No.: ( 9 '7d) ~0 7~7- ~ 7 3 1 ~ <br />FaxNo.:( 970) lD7'7-~~'/S <br />Signature of Corporate Officer r Owner <br />Date <br />M:~DNRM LNIASTERDN1~AF~09. <br />