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hhp <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'/ ANNiiAi, FF.F, and REPORT RF,OiTF.ST <br />//J-Rude, Inc. <br />M-1989-009 <br />J-Rude Inc <br />March 17, 2006 <br />~~ <br />RECEIVED <br />/MAR 1 ~ 2006 <br />Drv~s~on ri lpma~als end GaoloaY <br />/. . <br />$281.00 (Due on or before your anniversary date) <br />Prowers <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reciamation-accomgtishgd-to-date-and-during-the~izeedmgyear,~eco-disturbances-that-are-amicipatezl'to~cur'-- - <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 ynnr revised written annnal rennrt and annnal,~nrt m to this form- Please note that an <br />adequately labeled map that clearly 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: Rudy Tones <br />Permittee Name: J-Rude, Inc. <br />Address: 1750 CR HH <br />Lamar. CO 81052 <br />Phone Number: (719) 336-7361 <br />Fax Number: <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 />i <br />S~- re of orporate Officer, Owner, or Designee <br />3 /.3/ad <br />Date <br />