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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Stanley J. Conner <br />1987-072 <br />Lee No 2 Placer <br />September 26, 2010 <br />$$259.00 (Due on or before your anniversary date) <br />Gilpin <br /> <br />7 <br />40 <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 />op-erat_ shall submit the annual_ fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to Bete 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: Thomas J. MusJ' <br />Permittee Name: Stanley J. Conner <br />Address: 19140 Co. Rd. 31.9 <br />Weston, CO 81091-9752 <br />Phone Number: -e4q? 868-3; CELL $50 53© 89 <br />Fax Number: C F U_ 701 8895 ?_+8Z_ <br />If you e additional comments and/or information that should be provided to the Division, please provide it <br />bel or attach it to this form along with your written report and map. Annual Report instructions are <br />c sed. NC)JZ NO CHANGES FFDM LASTIt;AR- <br />ignature f orporate Officer, Owner, or Designee MINE S UI LL I NAM V E EXCEPT <br />FRo? f LL?? ©IG61Nb FRb?J T???' <br />Date <br />EASE NpTE ?W?ros OF CGt?? s YUA???? <br />PL <br />M:IPERMITIMASTERDOCUMENTS/M-AF-02. DOC