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<br /> 4 IYNIiA1. FFF and IiM'Pl)It'1' R F'(~1'F.ST <br /> RECEIVED <br />1'ERM1TIl'sG NAME <br />PGR:MI'f NO.: Uunicl M Russell <br />\I-1995-034 ~ fUl' 0 <br />OPIiRA'1'ION NAME; liachus 1'it U'v'smno!ldumu4 endGaalogr <br />ANNIVIiRSARY I)A'lli: .luk Itl, 2006 <br />ANNUAL PFIf I)1II:: ~6RR.00 I I)uc on or before you r anniversary date) <br />COUNTY' Vanurca <br />According u, ('.R.S. 34-32.5-I 16 or ('.K.S. 34-32-1 IG. each year, nn the nnnivcrsary date of the pertnrt, an operator <br />shall submit the annual fcc, a report and map showing the extent of current disturhnnccs to affected land, <br />nclnmation accomplished W date and dunng the preceding year, new disturbances that arc anucrpated to occur <br />dunng dre upcomrn}; yrar. reclamation that will he perforrtrcd during the coming year, the date, Cor the heguming <br />of ucncr ulxranuns. and the date acnvc opcrauons censcd lift the year. if any. <br />}'lease attach ynnr reciaed written ann ral rennrt and annual re nrt m• n to this form I he :\nnual Report <br />S Fee requirement is not met until we have received the following; 3 components: f._~e=rupnrt_ and ac,nclared <br />;a(%-It (:fll 3 arc required reKurdl~ys of the Ievel of disturbance or absence of disturbance durinK the previous <br />ycarl. !'ir,r~r nurr• thus rut urleyuarely labrfed map rlruf r•!eurly defineatt•s and inclrrdc;e dtr uhnve elemc•uty mrn• <br />~aJ/i. r !ur a nvvur•n n•purt. <br />Drviston n~:ords indicate the following pcrmittcc contact mformahon. Picric verify and make any necessary <br />changes: <br />Pcrmntcc ('ontact: 1)anrcl M. Russell <br />Pcrmnter Nante: Daniel M Russell <br />:\ddress: 9042 ti. 106 Rd. <br />Alamosa. CO 81 101 <br />i'honc Number: C~ ~ ~9 ~~ - 3[a,~ <br />Pax Number: (3.1!1)`S)W-3+•F~- _''} l°( ~~ - ~j(ex~o~ <br />If you have additwna) comments ancUor mfonnation that should lx: pn>vulcd to the Ihvrsiun. please provide it <br />helovv or attach tt to this form along with y«u written report and reap. Annual Report instruMtons arc enclosed. <br />~~ ~ ~ i <br />Signature u1 (brporatc OIliccr, Owner, or lh ignce <br />~~-u7•v~ <br />I)alr <br />