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f ~l <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMIITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Gallegos Corporation <br />M-1998-022 <br />Conger Harvesting Area <br />June 5, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Gunnison <br />Jt1N 0 6 2002 <br />Givision of Minerals and Geology <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 disturbance's'to'affected land-- - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual resort man 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; Robert M. Gallegos, Jr. <br />Permittee Name: The Gallegos Corporation <br />Address: P.O. Box 821 <br />Phone Number: <br />Fax Number: <br />Vail, CO 81658 <br />(970)926-3737 <br />(970)926-3727 <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 />/'t <br />Signature of Corporate Offic or Owner <br />6/y/oz <br />Date <br />~Nr U ,; ZUUt: <br />1NE G0.llEGOS CORPORRTION <br />M:~PERMITtMASTERDOCUMEMfSIM-AF-01 <br />