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-P, 1P *- Rp 7 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Ron Ebberts / <br />PERMIT NO.: M-1980-038 <br />OPERATION NAME: Disappointment Valle <br />ANNIVERSARY DATE: October 1, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />OCT 01 2000 ,/ <br />Division o> cyzs,,amavn <br />Mining si, i Zafs <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 preceding year, new disturbances that are anticipated to occur <br />---,--during the-upcoming-year, reclamatiori-that will-be pe?r?'ormed during the coming year, t e ates or t e eginning <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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's man are necessarv. 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: Ron Ebberts <br />'9? tm <br />Permittee Name: Ron Ebberts <br />Address: P.O. Box 250 <br />Phone Number: <br />Fax Number: <br />Egnar, CO 81325 <br />(970) 677-2476 <br />(970) 677-2776 <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 />Q /7. 4gT <br />Signature of Corporate Officer, Owner, or Designee <br />9 .9 9- 4 <br />Date