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999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> SEP 2 5 2001 <br /> PERMITTEE NAME: Stanley J Conner dGeolo9l <br /> PERMIT NO.: M-1987-072 plylsion of Miaetals as <br /> OPERATION NAME: Lee No 2 Placer <br /> ANNIVERSARY DATE: September 26,2001 <br /> ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br /> COUNTY: Gilpin ' <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during; the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that at <br /> adequately labeled map that clearly delineates and includes the above elements may since for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact Stanley J.Conner <br /> Permittee Name: Stanley J Conner v <br /> Address: 1683 S. Clarkson St. / Q2ui1L/1�rec+! Q ce �vt e 4 tP Cten.g. J'e <br /> loa073 <br /> Denver, CO 80210 Cd �Po A ro -o?o73 <br /> Phone Numter: (303) 722-9095 <br /> Fax Number <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or attach it to this form along with your written report and map. Annual Report instructions are <br /> enclosed. <br /> �!— <br /> i -1Y' <br /> Signature of Co$ofate Officer or Owner <br /> Dat <br /> M:TERMITNMASTE RDOCUNIENTSIM-AF-02 DOC <br />