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SEP-11-2006 03:33AY Fi'AIWItl ItECWMTION MINIf16 i SAFETY <br />3036320102 <br />T-121 P.003/003 F-314 <br />Lh'-~ <br />~ ANNUAL PEE nerd REPORT REQUEST <br />PERMITfEE NAME: <br />PERMIT NO.: ~/ Rudy R~dibaugh <br />~1-1_1995~057 <br />OPERATION NAME: RpdGbaaghPit <br />ANNIVERSARY PATE: Morel 7, 2006 <br />ANNUAL FEE DUE: 5281.00 (Doe o0 or lelore ytrar aaaivaary date) <br />COUNTY: Gnatt~oo <br />RECEA~/~~ <br />L SEP 12 2006 <br />/pivision of Reclamation, <br />Mining and Sareiy <br />According m C.RS. 34-32.5-116 or C.RS.3432-116, each year, oa the ~niveissy die of the pomi~ an operator <br />shall submit the anatwl fee, a tepoR and msp showing the ealatt of ctarrnt disnabanccs m at)'ected land, <br />techunation aowrnplishad to date a~ daring the preceding yea, ~av di~cahanca that are amicipated m occur <br />during the npcommg year,.tech®atiap that wiR be pafprmed during the cmnioe year, the dazes far the beginning <br />of active opnazions, and the date active operaaiorts ceased for t~ year, ifapy. <br />Please attarl voar rtvised tvrittea awpal report nerd anneal report uan m >lis fore. Tie Aapael Report <br />& Fce ragairem®t is mt tnd oitl we have reedved dte fot~ oompweats: fee, rcoprt, apd associated <br />~. I[~s o new disfarbaaas arr ret5~ttioa lave ocwmd darirti tk previops year aid ~p oev chaaees to <br />this is tle Aaaaal Report. Please note dal mr ader/r~ely labeltd mvp t!m clearly delnremes mcd aahdes the <br />above eleatatrs spy st~cefor a tvrinm report. <br />Division records indicate the folbwiag pamittee cattact ndortr~on. Phase verify and [oaks any necessary <br />changes: <br />Permlttee COnree~ Deb Rudibaug~t <br />Permfttce Name: Rtrdy Rndtlratrgh <br />Address: 7l1 Ranch <br />-~!~.o - <br />~ BaX ~~. <br />. P/ 17<f nl ~ Cc9 fl~lhllm R"/.Z ~// <br />Parlm, CO 81239 <br />Phone Nt®ber (970)641-0666 _ <br />Fax Number. (970) 641-0666 <br />1~70~~U1-.~5,7 <br />If you have additional cormnaaa and/or urfarmMion tbat should be provided m the Division, please provide it <br />below or attach it m this form slang witty your writieo report and anp. Amtusl Report inshttctioas are atcbsed. <br />~ ~~~ h~ ~L; L . <br />Sign re o rporate Officer, Owney or Designee /~/L/ <br />~ / l v i~ ~ <br />Date ` <br />iM ~~ <br />