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~~~ <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 />v Jordan C. and Jone L. Burdick <br />+~M-1987-092 <br />REGE'4"~~~,~ <br />z.i JUL f 3 2006 <br />B & G Stone <br />August 25, 2006 <br />:i" Oirisian of Minerals and GoaloBY <br />$281.00 (Due on or before your anniversary date) <br />Latimer <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 operator <br />-- shall-sutimiC'th"e anuual~t'ee,'a-report-and-map-showing-the extent-of currerrt-disturbances-to-affected land,- -- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). 'Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />Buff ce far a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jordan C. Burdick <br />Permittee Name: Jordan C. and Jone L. Burdick <br />Address: P.O. Box 1385 <br /> Lyons, CO 80540 <br />Phone Number: (303) 823-5943 <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 enclosed. <br />~' X <br />Si lure of~C/orporate Officer, Owner, or Designee <br />_"7 -~~~ <br />Date <br />