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,,\, iF -- 2-PT <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: V '?T'he Gallegos Corporation INVEn <br />PERMIT NO.: M-1998-022 JUN Z; 2010 <br />OPERATION NAME: Conger Harvesting Area Vj n of re <br />MIx scirart?r on <br />I/ <br />ANNIVERSARY DATE: June 5, 2010 iV and Safaly <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Gunnison <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 disturbances to affected land, <br />reclamation _accomplished to date and during the preceding year, new disturbances th C 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 />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 />Vail, CO 81658 <br />(970) 926-3737 <br />Fax Number <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 />Si ature of Corporate Officer, Owner, or Designee <br />,(-/Z i//o <br />Date