2003-09-18_REVISION - M1985008 ‎(3)‎

• Permit No: M1985008
• IBM Index Class Name: Revision
• Doc Date: 9/18/2003
• Doc Name: Cert.Mail Receipt
• From: DMG
• To: Orlando & Rose Marie Martinez
• Type & Sequence: SO3
• Media Type: D
• Archive: No

~~,
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Elbert County
M-1982-211
Thompson Pit 3-2-82
December 16, 2003
RECE~~E®
DEC 1 5 2003
Division of Minerals and Gealoo~
$688.00 (Due on or before your anniversary date)
Elbert
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 shall submit the annual fee,'a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vmir revised written annnal r ~nnrt and annnal rennrt map to this fnrm_ Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Marilyn Sproch
Permittee Name:
Address:
Phone Number:
Elbert County
809 Ute Ave.
Simla, CO 80835
[phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions aze
enclosed.
Signahue o~rpora _ er, Owner, or Designee
~c~v . 02~ U 3
Date --.
M;IPERMITIMASTERD000MENTSIM-Ar-04