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S <br />I <br />ANNiiAi, FF.F. and RF.Pt)RT RF.t7iiF.ST <br />~~.,1- <br />PERMITTEE NAME: Urralburu Mining Company FEB 1 t 2004 <br />PERMIT NO.: M-1977-501-UG Oirision of Minere <br />OPERATION NAME: Marietta Mine <br />ANNPJERSARY DATE: February 15, 2004 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />According to C.R.5. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shat submu the annual ee, a report and map showm`g~tie ezterit-of current distur(iances-to-aif~eteu <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 />Pleat a tarh ynnr revised written anmial report and annnal report mTp 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: Benedicto Urralburu <br />Permittee Name: Urralburu Mining Company <br />Address: 205 N. Willerup Ave. <br />Montrose, CO 81401 <br />Phone Number: (970) 249-5208 <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 />Grp ~/.L/./l- <br />Signature of Corporate Officer, caner, or Designee <br />~- 9- a oo~~ <br />Date <br />MIPERMI7IMASTERDOCUMENTS/M-AF-02.000 <br />