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<br />RECEIVED <br />MAR 0 3 2004 <br />PERMITTEE NAME: Georgia Rubeck -Walt Rubeck <br />Division of Minerals & GealoBY <br />PERMIT NO.: M-2002-003 <br />OPERATION NAME: Topaz Mt. Gem Mine <br />ANNNERSARY DATE: March 26, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 <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 your revised written anmral rennrf and annnal reQnrt man to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following petrnittee 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 along with your written report and map. Annual Report instru tbons are <br />enclosed. ~ 9YJ.yr~- tp $.~R~ftitQ Comp/~fi~u/w..z~-~brms <br />o .`-' {~,L/1_eC~ayy.~QcOO~e,.Jl.np/lYrli~'l-, ~j7/:.c•~-wt COHS~de-raGl~. <br />~I (( TiQ, yyyt~-~'~'~' ~N-~ ~/1-~,rr c -~° -c(/a?~~'~ 0 <br />Signature of Corporate Offi/c/er, Owner, or Designee ~~ ~ S'o ~' / ~'~'~-t./a>~~'o~rf - q <br />s~ - ~ - O y- ~if/4G .r.~~h /y~»''e/t.ee.~a~naY"i~a~v <br />Date l+/ .. /J~~GLP~- ~ QvGr~o'7ti/ <br />M:~PERMITMAS7ERDOCUMEMS/M-AF-02.DOC <br />