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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTJAT. FRF, and RFPnRT RF,(HiF.ST <br />Ted R. Hubbs Family Trust <br />M-1987-088 <br />Hubbs Pit <br />July 14,2003 <br />RECEIVED <br />JUL 1 1 2003 <br />Division ~f Minerals and Gealo~y <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 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- 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 />Please attach ynnr revised written anmral re~nrt and annual re nn rt maw 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 permittee 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: (928) 692-6208 Q Y ~ ~- ~ - ~p G ~ - ~ ~ 4 `~ <br />Fax Number: (928) 692-9715 <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 />~i~i~ ~/ <br />Signature of Corporate Officer, Owner, or Designee <br />~OD~ <br />Date <br />M:\PERM ITV.IASTERD000MENTSVN-AF-01 <br /> <br />