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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A rr *- <br />ANNUAL FEE and REPORT REOUEST <br />Mason King <br />M-1981-309 <br />V.F. Smith Pit #5 <br />August 27, 2008 <br />RECEIVED <br />AUG 0 6 2008 ?? <br />Division of Reclamation, <br />Mining and Safety <br />$323.00 (Due on or before your anniversary date) <br />Washington <br />_?_ _ Ac?nxding to $ S 3 116._or C.R S 34-32-1 lf, each wear, on the an_ niyersary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the <br />upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active <br />operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report may to this form. The Annual Report & <br />Fee requirement is not met until we have received the following components: fee, report, and associated map. <br />If no new disturbances or reclamation have occurred during the previous year and no new changes to the <br />previous year's map are necessary, then no new map is required, provided that the Operator shall state this in <br />the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Mason King <br />Permittee Name: Mason King <br />Address: P.O. Box 68 <br />Cope, CO 80812 <br />Phone Number: (970) 357-4245 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form long ' h your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />g_o ( - og <br />Date <br />M: \PERMIT\MAS TERDOCLTMENTS\M-AF-04