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A-eSl- <br />c <br />ANW&L'FEEArnd O T REQUEST <br /> <br />PERMITTEE NAME: A "in Mosch - Patricia Mosch <br />PERMIT NO.: ( ZJ1982-075 <br />OPERATION NAME: Phoenix Mine <br />ANNIVERSARY DATE: June 14, 2011 <br />ANNUAL FEE DUE: $$259.00 (Due on or before your anniversary date) <br />COUNTY: Clear Creek <br />RECEIVED <br />'I AY11.L, <br />Division of Reclamation, <br />//, (Mining & Safety <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-shal?-submit-the-annual-fee;-a-report and-map-showing-the-extent:of_cutxent.disturbances_to_affe.cted ,__ <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 man 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: Alvin Mos <br />Permittee Name: Alvin Mosch - Patricia Mosch <br />Address: Phoenix Gold Mine <br />-P.O. Box 3236 <br />Idaho Springs, CO 80452 <br />Phone Number: (303) 567-0422 <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 />Signature of Corporate Officer, Owner, or Designee <br />JAI/ q 2 of/ <br />Date <br />pnnvlo4 Ref'OR <br />T ?,e Rt Ip R,? n o e E-Jly K ? rs <br />M: (PERMITIMASTERDOCUMENTS/M-AF-02. DOC