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� i <br />L FEE mid REP RT REQUEST <br />PERMITTEE NAME: II Vasquez Sr <br />PERMIT NO.: .A1-2000-089 <br />OPERATION NAME: Perdue <br />ANNIVERSARY DATE: October 4, 2011 <br />ANNUAL FEE DUE: $$323.00 (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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamatik accomplished_to date and during the precedingyear, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates or 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: Ignacio Vasquez Sr <br />Permittee Name: Ignacio Vasquez Sr <br />Address: P.O. Box 938 <br />Lyons, CO 80540 <br />Phone Number: (303) 823 -5684 <br />Fax Number: <br />/4— 1/— A0/1 <br />Date <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 />Signatdre of Corporate Offer, wner, or Designee <br />d Oa <br />122011 <br />jOhtsinn of Rec►ems <br />Mining & Saregy <br />ui. l ( /Y1cxe de rk..- <br />1.6a,4 it c( c,r'1/codter <br />