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II(r,7i- <br />21 CL ~ £5 :.~5`tlo <br />\\til'AL FF:F' and NF.I'OIZf Itf:Ut E'1~ RECEI~/ED <br />' AUG 2 3 2006 <br />I'I I(\11'I I I?I N:ARlf: ~ Kacu C'uunh i!i r.t~~°,~ "r''`'-i: m~,,1q~n. <br />l)I'LI(A I If IN N:\~il. Graccl I'it Vo 7 <br />\\NIVF.K~:1k1' D-\ I L lcplcmbcr 11, 211116 <br />\\'Vl';11,flifl)I'I: T68N.IIIIIUucnnorbcfarcyuuranniecrsandaul <br />('Ol'N 11' Kuca <br />Aceonlinc G, l.it.1 i3.3?.>-I Ib ur C.R 1. ~J-i~.l 16, c:r.h }car, un Ilic anni,cr.ar~ Jatc ~,I the pcrnut. ;m <br />operator :hall uihmil the annum iec', a rcpun and mop ,hovving dte c~tem nl current Ji,turhanec; I„ at7ccted <br />haul. rrclanuuion accumpli,hcd to Jate anJ during Ihr prcecdirtg year. nrta di,lurl+,mre, that arc anticipated to <br />occur during the upeomin~ year, rcclamauon that ,+ill he pcrl„rmed durine the conun~ tear. the date, tar the <br />hcginnmc ,~I u;titr.q,cratinn,..utJ [hr Jatc ,elite nprrati,au era,c,l G,r the Vicar. ~t .ui~ <br />I'Icase attach vuur tt•v ix•d t, rittc•n annual rc•nort and annual rcnurl own 1n Ihis form. lYrrrsr rtorv rHru mr <br />~tJt•yuuleh luhclyd roar rlurt c/rur/r elrlinrures curl irrilude-c rhr rrburo rlrnrrnrt nrue sub/ic'r Ii,r ,r nrlrrrr <br />rrlrurf. <br />I)itision records indir.UC the li,llwving permitter contact intitn»ation Please verify and make arp necessan <br />hanrrs: <br />Penniuer Cnnlact: I n» l rant <br />Pernnucc Nanir: Kaca C ,rung <br />\JJrc" 'lI Mainlt <br /> <br />Phone Number 17191 >' J n; t ' <br />Fns Number (719);:1-t,>tiJ <br />II you hoer aJJitional conuncnl, and'nr inli,nnatiun thal ;hou1J he pnnadcJ lu the I)ivi,ion, please provide it <br />helwv ur altaeh it to thi; t~,nn elong ttith your ttrilien report nnJ map. :\nnuai Report in;tnlction, arr <br />eneln,rd. <br />i-1- 4~t,...y <br />Sign;ytt 'c ufCorE>,+ratc 1 tlJicer. (ritncr. ur Designee <br />17utc <br />ti I'I If 1!I 11.11+ I I If: N n. 1 t11 N'I ~ N- U ~ul <br />