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~~ ,~ ~, P~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />Rudy Rudibaugh <br />M-1995-057 ,~ <br />Rudibaugh Pit <br />,cF ~~ <br />e2,~ ~O <br />17t~~sinn Zoo <br />M%n~nga aS~~a 8 1// <br />af~~, on, l,/ <br />March 7, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />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 daring. 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 vour revised written annual report and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />ma If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />.Helms <br />~T~~Sr~a~ ~- .~1~ H~LVI~S <br />Rudy Rudibaugh <br />P.O. Box 202 <br />Pitkin, CO 81241 <br />(970) 641-3057 <br />(970) 641-1195 <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 />~ ! , <br />( / <br />Sig a~/ore of C,or/porate Officer, Owner, or Designee <br />T/a 7/OlS <br />Date <br />~'e~ol^f~= h0 ~~~ ~~ hPUJ lSfur,~ ~f'I~C~,S D~~ ~ o~8e /~'lA~~ ON ~'i~E <br />