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~;~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />,i Rocky West Mining Corp. <br />~'I1I-1982-058 <br />Poorman Mine <br />June 14, 2007 <br />$$225.00 (Due on or before your anniversary date) <br />Clear Creek <br />„ ' „on <br />~~ <br />--~Lecording-to•C-.R.S. 34-32.-5-1-I6-or-C.R_5~4.32_116,.each_year. on the anniversary_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 />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 [he year, if any. <br />Please attach vour revised written annual report and annual report mau to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred durin¢ the previous vear and no <br />new chanties to the urevious year's moo are necessary, then no new mau is required, arovided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Alvin Mosch <br />Permittee Name: Rocky West Mining Corp. <br />Address: Box 3236 <br />Idaho Springs, CO 80452 <br />Phone Number: (303) 567-4565 <br />Fax Number: <br />j`A I~,e ,e ~ S C !9' t T <br />A .w <br />9K1~/~q UG'D N ~iLG" <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 />Gy-i10~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />-x- o <br />~~ <br />~~' <br />~• <br />/ ~ .. ~<' <br />M:~PERMITNIAS7ERDOCUMEMS/M-AF-02.DOC <br />