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... - <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1717 Sherman $i., Room 21 S J <br />` <br />. <br />Ocnver, Colorado 8020] I~ <br />~~ <br />Y <br />Phone: 17031 865-7 567 AVS Annual Review I I <br />FAX: (}071 872-8105 Iaspectioa Worksheet <br />DEPARTMENT OE <br /> <br />' NATURA I <br />Date z a / <br />•~~ 19~r' T RESOURCE <br />C~~~ ~Llr>c e / G -. y ( -- c / q Roy Romer <br />114ine Name/Permit Number Ce/uw <br />~ Governor <br /> <br />InspeetorSignature ~~~ J• Lr/~ lames 5. Lxhhead <br />EaecwiveDireclor <br /> Michael B. Long <br />Based on your on-site observation, please answer the following: o...sion oirenor <br />I) Mine ID sign <br />a) Permittee Ca Cu •- v v C~ o~ C~w,au--~ L /' , / <br />T D'rl l y CrTA .JT x ~ e1 <br />I <br />J <br />b) Operator CoCo~ L_,~..~ Coay~o.., C • /~ L/ <br />,- <br />c) MSHA ID D S -- v Z 9 G L <br />2) Direct inquiry (of persons on the site) ~ J•'" ~Trjr~" <br />a) Permittee ~,, C,,,~~ C , /~ <br />b) Operator ~ Cc r/ ~,,c rrh L • ~ r <br />c) MSHA ID U s -' v 2 9 6 Z <br />3) Ts ownership/control information for permittee and operator noted in field consistent with <br />what fs listed in the permit application? Yes ~ No <br />If No, what is in conflict? <br />DMG is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annualy as long as coal extraction <br />from the site has not been completed, DMG must determine whether ofFcer/controller information is <br />complete and accurate in AVS. In making the determinationof complete and accuratdnformation, on-site <br />observations and direct inquiry of persons on the site is necessary. The information on this form will be <br />verified with AML, MSHA, and EIA information in AVS. Please return the form to Erica Crosby to be <br />verified in the AVS. <br />c:lesc~avslannual <br />