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c <br />~~~~~ <br /> ANNUAL FEE and REPORT REQ UEST <br /> <br />PERMTTTEE NAME: <br />/LKA International Inc. `' .~ <br />? - <br />~ <br /> <br />PERMIT NO <br />: <br />~M-1978-091-UG ,~ <br />°~, <br />>. <br />. ~ <br />OPERATION NAME: Golden Wonder Mine /~ ~ <br />= ~~ <br />' <br /> <br />ANNIVERSARY DATE: <br />October 1, 2007 r/ <br />~ <br />t <br />ANNUAL FEE DUE: $$518.00 (Due on or before your anniversary date) -' <br />COUNTY: Hinsdale <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 />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 the year, if any. <br />Please attach your revised written annual report and annual report man to this form.. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous.year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided 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: Lan arker 'j` ~~ 148RA ~ SAM <br />Permittee Name: LKA International Inc. <br />Address: ~~T <br />C ~s ~lio~o~2.; t~~ <br />~~335 <br />Phone Number: -~9~}9~~}- ~ ~t.~ g(P <br />amass ~s <br />Fax Number: 0~3 ~J~l _ ~~ <br />If you have additional comments and/or i formation that should be provided to the Division,. please provide it <br />below or attach it to this fo~n along, with your written report and map. Annual Report instructions are <br />enclosed. ~ ~~~ ~ <br />c ~.~~~-N-~ ~. A a o,~ ~,~.~ <br />~I,O~N~' <br />of Corporate fficer, Owner, or es' ee <br />_~~~ ~- ~ <br />Date <br />M:~PERMIT~MASTERDOCUMENTS/M-AF-02. DOC <br />