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~ o~ ~ ~ <br />~~~ ~~ <br />~~ <br /></ ANNUAL FEE and REPORT REQUEST ~ rt-,r, T ~~ Obs'~ <br />PERMITTEE NAME: `/ Dolores County ~EB 131007 <br />Divi;icn o. 2ec;a~stion, <br />PERMIT NO.: M-1995-010 Mining and Safety <br />OPERATION NAME: Black Snag <br />ANNNERSARY DATE: March 24, 2007 <br />ANNUAL FEE DU$: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Dolores <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 sfiall 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 perfonned 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 resort mao to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated maa. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the arevious year's mao are necessary, then no new map 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tim Huskey <br />Permittee Name: <br />Address: <br />Dolores County <br />P.O. Box 608 <br />Dove Creek, CO 81324 <br />Phone Number: (970) 677-2328 <br />Fax Number: (970) 677-3759 <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 />ignature of Corporate O~tEer, Owner, or Designee <br />n~ - 0~ `d7 <br />Date <br />M:~PERMI7UTASTERDO('UMENTSUI-AF-04 <br />