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//~/~I 1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Yuma County <br />/ICI-1999-047 <br />Adamson Bros. Mine <br />May 10, 2007 <br />RE~~r~i,~f~ <br />~IJUN 2 ?007 <br />Division of keuama6p;~, <br />r/lLlinin9 and Sash <br />-Y <br />$$281.00 (Due on or before your anniversary date) <br />Yuma <br />Acco~r ing t---o CZL:S 34=323=1-1~oi CR:S:-34=32=1-16, eac}fyear, on tfie anriivers`ary date of tfie 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. 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 durine the previous year and no <br />new changes to the previous year's map are necessary, then no new man 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul Like <br />Permittee Name: Yuma County <br />Address: 1310 S. Blake St. <br />Phone Number: <br />Fax Number: <br />Wray, CO 80758 <br />(970)332-5718 <br />(970) 332-3429 <br />If you have additional comments andlor 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 />~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />07 <br />Date <br />M:~PERMI7IMASTERD000MENTSM-AF-04 <br />