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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />i:?VwNuak 4011111? <br />ANNUAL FEE and REPORT REQUEST <br />ti <br />San Miguel Cout" <br />M-1981-220 ::>-* <br />1 ? 200?i ? <br />c:u?ation, <br />pivisic and Szilr7Y L'31 ?O <br />@fining <br />OPERATION NAME: Klondike Pit <br />ANNIVERSARY DATE: November 20, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />According to._Q,.R.S. 34-315.-116 or C.R.S._34-32m-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 map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components. fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new chany-es to the previous year's may are necessary, then no new may 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: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Norwood, CO 81423 <br />Phone Number: (970) 327-4835 <br />Fax Number: (970) 327-4090 <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 />Signature of C rporate Offi r, Owner, or Designee <br />ab, 1h 'F <br />Date <br />M:\PERMITVMA STERDocuMENTS\M-AF-04