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Apr 16 2010.16:44 GARRETTS 17858744858 page 3 <br />AV: * P-f T <br />PERWME NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ Wil bur F Benham <br /> <br />M-1 <br />J <br />98"39 "*"'APR 2 3 2010 <br /> .11 <br />Tol ec No 2 <br />/ Division of kaciarnrpion <br /> <br />Ap ? Mining and Safety <br />ZS, 2010 <br />S29 .00 (Due on or before your anniversary date). <br />San 1juan <br />to C.R.S. 3432.5-116 or C.R. <br />- -. -- . _ , opmtor shalt mbmit_ be tunuaLfee,:Aj <br />land, reclamation accomplished to date <br />occur during the upcoming year, reclan <br />beginning of active operations, and the <br />Report & Fee requirement is not met <br />delineates and includes the above <br />Division records indicate the following <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />F. Benham <br />Wilbur F Benham <br />?ceti <br />Norton; KS 67654 <br />Phone Number. (785) 8748080 <br />Fax Number. 1V6A)'e <br />3432-116, each year, on the anniversary date of the permit, an <br />rand mapEsbowhig rhi-extent of cauren+- Lshirbances_to af6Wted__.. - .. .. <br />during the preceding year, new disturbances that are anticipated to <br />in that will be performed during the coming year, the dales for the <br />active operations ceased for the year, if any. <br />report and annual report man to this form. The Annual <br />we have received the following components: fee. report. and <br />,cart. Please note that an adequately labeled map that clearly <br />may suffice for a written report. <br />contact information. Please verify and make any necessary <br />ve ; #'3#f <br />If you have additional comments and/or ormation that should be provided to the Division, please provide it <br />below or attach it to this form-along wi your written report and map. Annual Report instructions are <br />enclosed. <br />of Corporate Officer, Owner, <br />Date <br />se cu?ns ocutv?rrrsn?t a? 02JXC