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• ~K#171 n ~IIII~IIIIIIII~~II~ ~ <br /> <br />ANNUAL REPORT <br />PERMITTEE NAME: Ron Ebberts <br />PERMIT NO.: M-1980-038 SEP 2 0 200 <br />OPERATION NAME: Disappointment Valle ll~vision of R9inerals and Geology <br />ANNNERSARY DATE: October 1, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $281.00 <br />COUNTY: San Miguel <br />_ _ According to C.R.S. 34-32.116(3)(a), each yeaz, on the anniversary date of the_permit, an operator shall _. <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised annual report map and written report to this annual report. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: n r /1 <br />Contact Name: /~ Dn/~ rib b e y' f s Company: Gph 6 e ~S 1.Oh S't< <br />Address: ip ~• ~ O X ~.J ~ Phone No.: (7 7~) ~ 7 7 -a y ~ <br />1'l c~ I'` ~ C D • ~~.3 0? .J FAX No.: (9 701 (0 7 7 -a 7 7/o <br />e-mail: <br />If there aze additional comments and/or information that should be provided to the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. <br />!J~ m~ ~~~- 9 - /~P - 0 0 <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M:~PE R M R V.7 ASTER DOC U M EMS VA- AF~ 01 <br />