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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I <br />4' <br />ANNUAL EE anal REPORT REQUEST <br />)J-Rude Inc <br />V(W-1989-009 <br />J-Rude Inc <br />March 17, 2010 <br />$$323.00 (Due on or before your anniversary date) <br />Prowers <br /> <br />ECEIV 0 <br />/hAR 112010 <br />®ivioioo of Reclamation, <br />Mining & Safety <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 ate. and. during. the recO ig 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 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 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: Rudy Torres <br />Permittee Name: J-Rude Inc <br />Address: 1750 CR 14H <br />Lamar, CO 81052 <br />Phone Number: (719) 336-7361 <br />Fax Number: <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 />igna ` re of Corporate Officer, Owner, or Designee <br />12 &A 9 0?o/0 <br />Date