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y(7~ <br />Piilt,Ml l"I'CL NAfaU: <br />1'GUvll"1' NO.: <br />Oi'L•'RA"PION NA;vIL: <br />ANNIVGIZSAKI' DA"1'1::: <br />ANNUAL FI;G Dl1G: <br />COUN"1'Y: <br />~wNnnf rf~a~ end lcf~ r~u'r x1rc~111:~L <br />Suthcrl:utd Brothers, inc. <br />119-19'I6-U31 <br />Wcuucr Nu. 2 <br />July 2, 2U0!1 <br />$2SIAU (Uuc uu ur before your auuivcrs:u'y date) <br />lVlunirosc <br />RECEIVE® <br />SEP 2 4 2004 <br />Division of Minerals and Geology <br />Accurdiug to C.R.S. 34-32.5-1 IG ur C.Ii.S. 34-32-1 l(i, each yc:tr, on tltc anniversary date of the permit, :ut upcr;nur <br />shall submit thu uunual Ice, a report and trap showing the cxtcui of current dislw'bauces W ullcctcd land, <br />rcclantatiuu acwugtlishcd to date :md during the preceding yaar, new dislurb:utecs that ;u'c anticipated W occur <br />during the a teuutiug yu:u, roelaucttiun that will be perluruted during the cumiug year, the d:acs ILr the be~iuning <br />ul activu up~iutiuns, and the date active upu;ttiuu:; ceased Cur the year, it any. <br />jyt;atic a.E:; -ft cut l' rcti :.-cd ~r ri'tcn ~+unt•al report and ~utsr. rtl ru~urt mint this form. Plcrtsc no(e Ilrcr/ un <br />uc(er/t«r(e/y iubr/crl nugt (hu( cl~ur/y c/e/iaccr(es un~(inciudes //li ubuv~ elenrrn(s rpcr~•.rtrffice /or cr n•ri(!en rrpur(. <br />Division records indicate the lulluwing permittcc cuutucl iulurututiun. l'leaau verily and nmke any accessary <br />cbaugcs: <br />1'cnnitlcc CuntacC 13ob Suthcrlaud <br />Pcrmittec Name: 5ulhcrland l3rothurs, loc. <br />Acfdress: '__"I7U3 lltvy. )7 <br />I'.O. 13ox 8,i') <br />1'lSuuc Nun.bcr: <br />Put Nuutbci <br />Nuda, CO S!42•I <br />(970) ~(i4-7602 <br />(l70) Y54-TJSO <br />N~ <br />If you hour additional conununts and/ur iulormatiuu that should bu provided to lho Division, please provide it <br />below ur attach it lu this lurm uluug with your written report and map. Annual Repurl instructions arc enclosed. <br />Siguaturc of Corporate OCliccr, Owuu, ur Dcsiguce <br />_Septejn_er 13, 2004 ___ <br />AI:AI'I ]0.111 UTA> I bILUUt'I IM1Iii N'15VAI~AF-ul <br />