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~~f~P~' <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Wed R. Hubbs Family Trust <br />PERMIT NO.: ~iGI-1987-088 <br />OPERATION NAME: Hubbs Pit <br />ANNIVERSARY DATE: July 14, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <br />N~ <br />R~GE~~~ p <br />'~;l uN 18 200 <br />Div/i~sion of keclamation, <br />/"'min9 and Safety <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator <br />reclamation accomplished to date and during the preceding year, 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 />Please attach vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's map are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bazbara Hubbs <br />Permittee Name: Ted R. Hubbs Family Trust <br />Address: 7994 E. Saddleback Dr. %(,$'~ ~ (~~+~ rye <br />Kingman, AZ 86401 ~ d / <br />Phone Number: (928) 692-6208 <br />Fax Number: (928) 692-9715 <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 />Sign'atu're of Corporate fficer, Owner, or Designee <br />Dat /~ <br />