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ANNUAL FEE and REPORT REQUEST $ <br />FHB ~ ~® <br />PERMITTEE NAME: Joseph L. and Arlene Cogan ~~~ ioy cry rZ~QB <br />PERMIT NO.: M-1998-091 t~tn~~ndSa e~ on <br />OPERATION NAME: Arnold Gulch <br />ANNIVERSARY DATE: February 19, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />- - --reclamation-accomplished-to-date and- during the- prccedir~g year; new-disturbances that-are anticipated-to--o~cur - - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 map to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Joseph L. Cogan <br />Permittee Name: Joseph L. and Arlene Cogan <br />Address: P.O. Box 113 <br /> <br />Nathrop, CO 81236 <br />Phone Number: (719) 395-2339 <br />Fax Number: 1~iJ,'/'~. <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 enclosed. <br />~ (~.~" <br />Signa re of Corporate Officer, Owner, or Designee <br />,~~ 7 08 <br />Date <br />