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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Ted R. Hubbs Family Trust <br />M-1987-088 <br />Hubbs Pit <br />July 14,2002 <br />RECEIVED <br />JUL 1 11001 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />La Plata <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 pemut, an operator <br />s a s'h~tl uiSm~i Yh u e, a e a r ', , ~ r nt'-distarbances 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, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />t <br />Please attach your revised written annual report and annual report map 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 petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Barbara Hubbs <br />Permittee Name: Ted R. Hubbs Family Trust <br />Address: 7994 E. Saddleback Dr. <br />Kingman, AZ 86401 <br />Phone Number: (520) 692-6208 <br />Fax Number: (520) 692-9715 <br />9~ / 9~ lo~D~' <br />9~r~ ~ 9a- 97i_s- <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 />/u .s i ~ ~/s-~2/ <br />Signature of Corporate Officer or Owner <br />~- 0~41~- <br />Date <br />M:~PERMITNIASTERDOCllMENTSVN-AF-OI <br />