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`?A? <br />",-7-- <br />ANN r'EE and P RT REOUEST <br />PERMITTEE NAME: 9' Mason King <br />PERMIT NO.: ?M-1981-309 <br />OPERATION NAME: V.F. Smith Pit #5 <br />ANNIVERSARY DATE: August 27, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Washington <br />coi) <br />SEP 0 3 2009 <br />DiVWW of Reclamalon, <br />Mining and Safety <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 <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 rtu ng t1-te preceding year, new dista-rb-Etices-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 vour revised written annual report and annual report man 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 chanEes to the previous vear's map are necessarv. then no new map is renuired, 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: ??Al P epos <br />Permittee Contact: Mason King -e rrt Girt r o vl2w <br />Permittee Name: Mason King <br />Address: P.O. Box 68 <br />Cope, CO 80812 <br />Phone Number: (970) 357-4245 <br />Fax Number: <br />So no hew YriecD i S 14 V--e-4 k- <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 />Signat- re of Corporate Officer, Owner, or Designee <br />Date <br />M: \PERMIT\MAS TERDOCUMENTS\M-AF-04