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IV <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />7-H-025 >? <br />6 mk-- <br />W- own <br />1,,'/APR 2 3 2010 <br />Division of Roc*rAjion, <br />11-0 Mining and Safety <br />AN NU L FEE and ORT RE UEST <br />?Bdian Springs Mining <br />V/1-1981-020 <br />Thorsen Mine <br />May 6, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 />reclamation accomplished to-date- and during the -preceding-year,-new disturbances that are _anticipated to occur <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 map are necessary, then no new map 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: 0ar-1' C)j-J 't6rS d-n <br />Permittee Name: Indian Springs Mining <br />Address: 3257 CR 67 <br />//? fi-N <br />Penrose, CO 81240 <br />Phone Number: (719) 372-3907 U 1;?-' C-7 1 Q) q-7 S"-- 56 63 <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 enclosed. <br />Signaturof Corporate Of icer, Owner, or Designee <br />6 ?- / 5?1' w? <br />Date