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l~- PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNUAL FEE and REPORT REQUEST Caldwell Brothers M-1986-016 Caldwell Brothers 3 ANNNERSARY DATE: June 1, 2002 RECEIVED JUN 0 3 2002 Division of Minerais and Geology ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) COUNTY: Otero According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator __ shall .submit theannual fee,-a-report-and-map showfng the extent of current-distmfiance~[ti afPec[ed-tand;- -- reclamation accomplished [o date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report maa to this form. Please note that an adequately labeled map that clearly delineates and includes the above elements may s~ce for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Wayne Caldwell Permittee Name: Caldwell Brothers ttia,5e o~ ~ Address: X26333-ffwy~T ~ d dress Rocky Ford, CO 8]067 a5aa~ Rdt 19 Goa. Q n Phone Number: (719) 384-5256 ~ ~ ~l 9 - d5~f - 3a / o Fax Number: If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written llr/Ieport aDn~d map. Annual Report instruc~¢~~L ~ sed. Sign ture of Corporate Officer or Owner n~u ^•v^r ~~~<r-f ir~v ~L!"'~Q ..fie ~4~-~'~~' Date /J,~.~-,.,,~aE? /C~.:~t ,~~d- "~ ~.,-" ~cc'ti.~-'mac ~~~a~°~fi~""~ ~ .~ 'r^~""'.,"~ ~e-r2~.~~rrw ~ -ire ~9usP~ub- - M:(FERMI"IIMASTERDOCUMENTS~M-AF-OI ~~k ^~~ ~/