REP00962

• Permit No: M1978066
• IBM Index Class Name: Report
• Doc Date: 10/22/2004
• Doc Name: Annual Report and Fee
• From: Rio Grande County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Rio Grande County
M-1978-066
10 Miles South Pit
October 22, 2004
$688.00 (Due on or before your anniversary date)
Rio Grande
OCT 2 ~ 2004
Dirisian of Il7inerals & Geology
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 aze anticipated to
occur during the upcoming yeaz, 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 xpnr revised written annnal re~prf and annnal regprt main M this form. 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: Lawrence "Buddy" Shaver
Permittee Name: Rio Grande County
Address: 168 N. Washington
Monte Vista, CO 81144
Phone Number: [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 are
enclosed.
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Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMIIIMASTERD000MENTSM-AF-04