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>r <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Georgia Rubeck -Walt Rubeck <br />M-2002-003 <br />Topaz Mt. Gero Mine <br />March 26, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Park <br />MAR 1 7 2003 <br />Division ~f Minerals and Geology <br />to C.R.S. 34-32.5-116 or <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach yaur revised written anneal report and anneal re~nrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffrce for a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Walt Rubeck <br />Permittee Name: Georgia Rubeck -Walt Rubeck <br />Address: 2010 Wold Ave. <br />Colorado Springs, CO 80909 <br />Phone Number: (719) 596-5492 <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 alone with vour written report and map. Annual Report instructions are <br />enclosed. <br />~~ ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />_ ~~, = ~ <br />Date <br />~~~~~~a~ ~~- ~;~~.~ <br />M:~PERMITMASTERDOCUMENTS/M-AF-02. DpC <br />