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IIIIIIIIIIIIIIII � cK �-�14 � <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Byron J. & LaLani R. Weathers elECEp:/'E® <br /> PERMIT NO.: M-1999-089 Nov 1 s L�jD <br /> OPERATION NAME: Weathers Mine#1 <br /> ANNIVERSARY DATE: November 18,2000 Division of Minerals and Geology <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Yuma <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 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 map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Byron Weathers <br /> Permittee Name: Byron J. & LaLani R. Weathers <br /> Address: 11955 CR 37 <br /> Yuma,CO 80759 <br /> Phone Number: (970) 848-2912 <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 /> Signatur f Corpor e Officer or Owner <br /> //-/5-on <br /> Date <br /> M'TERM r[W ASTERDOCUMENTMM-AF-01 <br />