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~S <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />(/ ANNi1Ai. FF,F, and RF.PnRT RF.IIiTFST <br />t/ YYuma County <br />V M-1999-047 <br />Adamson Bros. Mine <br />May 10, 2006 <br />RECEI9lEE® <br />/JUN 16 1006 <br />~ Division of Minerals and GeoloBY <br />$281.00 (Due on or before your anniversary date) <br />Yuma <br />rvt-~--~ <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.znd-during-the-preceding years new disturbanccs 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 ynnr revised written anmral rennrt and annnal re-port m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Paul Like <br />Permittee Name: Yuma County <br />Address: 1310 S. Blake St. <br /> Wray, CO 80758 <br />Phone Number: (970) 332-5718 r <br />Fax Number: (970) 332-3429 <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 />Signature of Corporate Officer, Owner, or Designee <br />S ~~-© <br />Date <br />M:~PEAMITMASTERD000MENTS1M-AF-04 <br />