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Aq? * R---r <br />l <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Harry Covey l ?P <br />PERMIT NO.: M-1988-081 AUG ® 2008 L,/ <br />ReclarnaVo <br />OPERATION NAME: Phil Sheridan Lode Division9 Ok and Sage] <br />ANNIVERSARY DATE: August 19, 2008 <br />ANNUAL FEE DUE: $86.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <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 />shalLsubmit-.the.annual_fee,=a-resort-and-map showing <br />- -the-extent ef=et?rrent disturbances to a€fectEd-lan3; rectam?iiori <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active <br />operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report may to this form. The Annual Report & <br />Fee requirement is not met until we have received the following components: fee, report, and associated map. <br />If no new disturbances or reclamation have occurred during the previous year and no new changes to the <br />previous vear's map are necessarv, then no new map is reauired, provided that the Operator shall state this in <br />the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Harry Covey <br />Permittee Name: Harry Covey <br />Address: 479 County Road 83 <br />Boulder, CO 80302 <br />Phone Number: (303) 442-0657 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Co rate Officer, Owner r Designee <br />Date <br />M: \PERMIT1MASTERDO CUMENTS/M-AF-02. DO C