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,f?q je P ?T <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Joseph L. and Arlene Cogan YWCOVED <br />PERMIT NO.: M-1998-091 <br />21 2010 <br />OPERATION NAME: Arnold Gulch Division of Reclamation, <br />ANNIVERSARY DATE: February 19, 2010 t Mining and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <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 />- - -rcctamuti- irr-accomp-lished-tom date-ancMuring-the-preceding-year, -new disturbances-that -are-anticipated to-eccur- <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <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 year's may are necessary, then no new may 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: Joseph L. Cogan <br />Permittee Name: Joseph L. and Arlene Cogan <br />Address: P.O. Box 113 <br />Nathrop, CO 81236 <br />Phone Number: (719) 395-2339 <br />Fax Number: 14clutl <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 />'',??yy t C <br />S' tore Corporate O ricer, weer, or Desi ee j'4' <br />Date <br />