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ANNUAL and REPORT REQUEST <br />PERMITTEE NAME: Alvin Mosch - Patricia Mosch <br />PERMIT NO.: ,/M-1982-075 ?dAY 0 ? 2019 <br />OPERATION NAME: Phoenix Mine <br />.r, <br />ANNIVERSARY DATE: June 14 200 <br />ANNUAL FEE DUE: $222&.60 (Due on or before your anniversary date) <br />COUNTY: Clear Creek <br />According to C RS. 34-32.5=116 or CKS. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a reporUand 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 upc o6- g-year, reclamation-that-will,-be- perfortnedacing the-carrtingyearrthe'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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessary, then no new map 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 maysufce for a written report. <br />Division records indicate the following permittee contact information: Please verify and-niake'any necessary <br />changes: <br />Permittee Contact: Alvin Mosch o-7 <br />Permittee Name: Alvin Mosch - Patricia Mosch <br />Address: Box-3236 <br />5 <br />Idaho.S <br />prings, CO 80452 <br />Phone Number: (303) 567-0422 <br />Fax Number:. <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 />Ta <br />