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<br />PERNIITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE. <br />ANNUAL FEE DUE: <br />COUNTY: <br />AL FiF, &xREPOW REQUEST <br />Tie dare corporation <br />?M-1989 -044 <br />Twin Crk Campground <br />Apri110, 2011 <br />SS323A* (Dne an or before your anniversary date) <br />Teller <br /> <br />ECEIV <br />AN 0 1 Z011 <br />Division of Reclamation, <br />-110 Mining and Safety <br />Aug to -R.& 34-323-116 or C1ZS. 34-32-116, each year, on the anniversary date of the permit, an operator <br />Mail subm t do aand lacy, a a*M aai imp showng Ae cx#ent of catrent disturbances to affected land, <br />reclamation accomplished to date and dam tic paocaiitg yew, acw dishobomms, that arc amMogsteai to anent <br />during the upc omiagyew, - I ¦a' ,a he +i curs ?,iMea<1i¦a ici?eDiwri.S <br />ofac kwapo rafims, aai the Aeftackw4perations ceased for the year, if any. <br />tltisiia ?t.i?¦aaaR ?ar.e anilr,inc re aiiA?ataMe??+itiimiarfarrp?,t?iutdaae'? aieF¦tcaa?dt raaciinoinics pie <br />aiatW? aa?'aser' 100 nPW <br />Dividaa M aalk iaiicarc dw invowipg pomilae cmdu t i1finnsemm i ai make any araoessary <br />+61111"M <br />Perini bee C mdaet liawii E Cl if ?---- <br />Peaari?ee Nam= 3ie4'Aw C+ q ation <br />Address: P.O. Box I <br />Flamm CO 80816 <br />Phone Number: (719) 748-3805 <br />Fax Number: (719) 748-5120 <br />If you have additional comments andkr micamabim dad sieald 4c pawed 1W 16C DMMMMk, please 1W"A it <br />below or attach it to this farat aimgwilb ywr aep?aatari A?aataal Mmc?Miar