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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Camp Bird Colorado, Inc. <br />M-1982-090 <br />Camp Bird Mine <br />December 7, 2003 <br />MAR r 1,% 2apg <br />Oitision o/Minerals and CeoloBY <br />$550.00 (Due on or before your anniversary date) <br />Ouray <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'shalt submirttre~antru~l-fee,-a relsort-and-map showng-the extent of current disturbances to a-ffe`cted <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 anneal re~nrt main to this form. P/ease 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: Scott A. Butters <br />Permittee Name: Camp Bird Colorado, Inc. <br />Address: P. O. Box 806 <br />Salt Lake City, UT 84110 <br />Phone Number: (801) 355-7260 <br />Fax Number: (801) 521-6400 <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 />~~/~ `R,t~o~ ~}2E.StaENT <br />Signature of Corporate Officer, Owner, or Designee <br />`~ /-~ k RL,6-l 200 <br />Date <br />M9PERMITA1ASTERDOCUM ENTS/M-AF-02. DOC <br />