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~jwt ~ <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUN'T'Y: <br />`~ Wallace F. Burtis <br />d M-2001-070 <br />Florence Pit <br />August 23, 2006 <br />v AUG 0 9 2006 <br />Division of Reclamation, <br />Mining and Safety <br />$225.00 (Due on or before your anniversary date) <br />Teller <br />~n I <br />,v[~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 yeaz, new disturbances that aze anticipated to <br />-__-.occur dtiring_the_upcoming:year reclamation_khat_will_he_nerformed_during_the_coming_year,_the_dates-for the -_ w <br />beginning of active operations, and the date active operations ceased far the year, if any. ~ <br />i <br />Please attach vour revised written annual report and annual report mau to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Wallace F. Burtis <br />Pemuttee Name: Wallace F. Burtis <br />Address: 66 Dartmouth Ave. <br />Phone Number: <br />Fax Number: <br />Pueblo, CO 81005 <br />(719) 566-1669 <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. Annum Report instructions are <br />enclosed. <br />Signature of Corporate Officer, er, or Designee <br />~'~ ~'-~~ <br />Date <br />M.~ERMI7IMASTERD000MEN7S/M-AF-02. DOC <br />