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PERMITTEE NAME: J -Rude Inc <br />PERMIT NO.: M- 1989 -009 <br />OPERATION NAME: J -Rude Inc <br />ANNIVERSARY DATE: March 17, 2012 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: <br />Prowers <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, 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 be inning <br />of active operations, and the date active operations ceased for the year, if any. g g <br />Please attach our revised written annual re ort and annual re . ort ma s to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee re ort and associated <br />man. If no new disturbances or reclamation have occurred durin the n <br />the revious ear's ma are necessa then no new ma is re uired • rovided that the 0' erator shall' es to <br />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 necessa <br />changes: ry <br />Permittee Contact: Rudy Torres <br />Permittee Name: J -Rude Inc <br />Address: 1750 CR HH <br />Phone Number: <br />Fax Number: <br />Date <br />Lamar, CO 81052 <br />(719) 336 -7361 <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 />Signature of Corporate Officer, Owner, or Designee <br />ANNUAL FEE and REPORT RE UEST <br />