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!I .r°? ANNUAL FE and REP R RE4UEST <br />-l V <br />PERA TTEE NAME: Rocky West ng Corp. <br />PERMIT NO.: ?'/M-1982-058 <br />OPERATION NAME: Poorman Mine <br />ANNIVERSARY DATE June 14 2007/ <br />ANNUAL FEE DUE: $$22500 (Due on r before your anniversary date) <br />COUNTY: Clear Creek , <br />t a.- According to C.R.S. 34-32.5-11"r C.R-Sr34-32-ll6, each year,. onn 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 <br />occur during the preceding year, new disturbances that are anticipated to <br />g 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 metuntil we have received the following components: fee, report, and <br />associated ma la. ' If no new disturbances or reclamation have occurred dnrin the Previous ear and no <br />new chances to the previous Year's may are necessary then no nevi map is reanired 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 awritten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Alvin Mosch <br />Permittee Name: Rocky West Mining Corp. <br />Address: Box 3236 <br />Idaho Springs, CO 80452 <br />Phone- Number:.. (303) 567-4565 <br />Fax Number: p <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 Corporate Officer, Owner, or Designee <br />Date <br />t <br />T _ _