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ANNUA FEE and REPORT REQUEST <br />ReCeIVED <br />PERMITTEE NAME: rrY Cove <br />y JUL 2 3 2U 10 <br />PERMIT NO.: M-1988-081 <br />OPERATION NAME: Phil Sheridan Lode Division of Reclamation, <br />Il?i?lr1 <br />9 & Safety <br />ANNIVERSARY DATE: August 19, 2010 <br />ANNUAL FEE DUE: $$86.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <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 :,xtent-ofcurrcnt disturbances to-affected- <br />land, reclamation accomplished to date and during the preceding year, new disturbances 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 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 year'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 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: Harry Covey <br />Permittee Name: Harry Covey <br />Address: 479 County Road 83 <br />Boulder, CO 80302 <br />Phone Number: (303) 442-0657 <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 />r ?wvter. <br />Can ? )/ ;. ? a0M <br />Signature of Corjffora-& OfficeE00wner, or Designee <br />Z-0 _ lQ <br />Date <br />M: PERMITIMASTERDOCUMENTS/M-AF-02. DOC <br /> <br />