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PERMfITEE NAME: <br />PERMFI' NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rudy Rudibaugh <br />M-1995-057 <br />Rudibaugh Pit <br />March 7, 2004 <br />G~ ~ <br />N <br />RECEII~> :~~ <br />MAR 15 2004 <br />Division of Miaerele @ Geology <br />$281.00 (Due on or before your anniversary date) <br />Gunnison <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />shall submit the...annuaLfee,_a_report.and_map_showing_the_extent~~curzent_disturhances_.to~ffected .land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Pl ar ca nttarh ynnr revicad writtan anneal rPpnrf and anneal red nrt ma,~n to thiv form. PleaS2 n0t¢ that Ari <br />adequately labeled map that clearly delineates and includes the above elements may since far a written report, <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Rudy Rudibaugh <br />Permittee Name: Rudy Rudibaugh <br />Address: 711 Ranch <br />Phone Number: <br />Fax Number: <br />Pazlin, CO 8!239 <br />(970) 641-0666 <br />(970) 64t-0666 <br />_~~P~ ~i LL.U / ~ In <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 enclosed. <br />note of Corporate ~cer, Owner, <br />~=6 ~uc+l.%ru y ti <br />Date O (~' G~ <br />