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<br />/ RECEIVED <br />/ NOV 0 7 2003 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Saguache County <br />M-1977-568 <br />Cooper Pit <br />November 25, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Saguache <br />~1 L~ilo~u CY IGL~ .. - _. <br />~., ,~ e ~--- -- <br />c:. _.. ~~ <br />__ <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 />operatcr-shall-submit-the-annual fee,-a-report-and-map-showing-the-extent-of-current-disturbances 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 />Please attach your revised written annual rennrt and anmral red nrt m ~n fn 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: John T. Ungefug <br />Permittee Name: Saguache County <br />Address: P. O. Box 476 <br /> Saguache, CO 81149 <br />Phone-Nnmb~e:- °(7i9)-6~Yi55#~- _ - " - <br />Fax Number: (719) 655-2543 <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 />igna~ttle of Corporate Officer, O fir, r i e <br />~~13~03 <br />Date <br />M:NERMIN7ASTERD000M ENTSVv1-AF-04 <br />