REP01570

• Permit No: M1987020
• IBM Index Class Name: Report
• Doc Date: 4/22/2002
• Doc Name: 2002 Annual Report
• From: Rio Grande County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Rio Grande County
M-1987-020
374 Pit
April 23, 2002
$688.00 (Due on or before your anniversary date)
Rio Grande
l \U
RECEIVED
APR 2 2 2002
Division of Minerals and 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
- ---lands reclamation-accomplished-to date=and during-the-preceding year,-uew disturbances-tharare`anricipated'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 your revised written annual report and annual report maa to this form. Please note that an
adequately labeled map that clearly cfeleneates and includes the above elements may suffice 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
P.O. Box 46
Monte Vista, CO 81144
Phone Number: [phone]
- Fax Number: [phone] ~-" ~ --- -~ - - ~ _n- ~ ~- _ _ - ~ -
If you have additional comments and/or information that should be provided [o [he Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
--'~~~~Z~~.~c-~-J
Signature of Corporate Officer or Owner
Date
M 9PERMTMASTERD000MEMS~M-AF-00