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<br />Y-40 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: 4a Boys of Cripple Creek Mining Co. Inc. <br />PERMIT NO.: yM-1996-081 <br />OPERATION NAME: Bad Boys Pit <br />ANNIVERSARY DATE: June 27, 2010 <br />ANNUAL FEE DUE: $$259.00 (Due on or before your anniversary date) <br />COUNTY: Teller <br />RECEIVED <br />JUL 2 8 2010 <br />-A5 WA*V&Sa1* <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 />.,nPraror shalt s„hr„it the-annual fee-a-repoftand man ah0Hing the _ex?t of current disturbances to affected- -- _ -- <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 annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map If no new disturbances or reclamation have occurred duriny- the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above 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: David Graham <br />I+PrAR']?-Fr 5496-0 8 M <br />Permittee Name: Bad Boys of Cripple Creek Mining Co. Inc. <br />Address: -5-.o7 9,4 yMd ?T <br />P.O. Box 66 <br />Cripple Creek, CO 80813 <br />Phone Number: (719) 699-i9H Lo G <br />Fax Number: (719) 689-2982 <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. Signature of Corpo ate Officer, Owner, or Desi ee <br />164 21 Zv a <br />D <br />M: \PERMIT\MASTERDOCUMENTS/M-AF-02.DOC