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Rl? * Q+-r <br /> ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Gil Moser <br />PERMIT NO.: /M-1990-059 <br />OPERATION NAME: Eldorado-Pilot <br />ANNIVERSARY DATE: May 21, 2011 <br />ANNUAL FEE DUE: $86.00 (Due on or before your anniversary date) <br />COUNTY: Ouray <br />RECEN <br />v111AY 16 2011 <br />piv{sion of Reclamation, <br />c% Wining and 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 shalLsubmit.rhe-ann_ ual fee, a report -and map showing the- .extent -of current-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 may 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 may 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. <br />changes: / <br />Permittee Contact: Gil Moser <br />VV o `c1 ?v? ?e S o `cam ?rObe <br />Permittee Name: Gil Moser <br />Address: 705 Crestview Dr. <br />Farmington, NM 87401-9106 <br />Phone Number: (505) 860-1728 <br />Fax Number: (505) 564-9609 <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 />I4? <br />-S 11$4 <br />Date <br />M:\PERNUr A4ASTERDOCUMENTS/M-AF-02.DOC