2006-06-09_REPORT - M1978192

• Permit No: M1978192
• IBM Index Class Name: Report
• Doc Date: 6/9/2006
• Doc Name: Annual Fee/Report/Map
• From: Chaffee County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

nft`~
~s~
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ANNTIAT. FF,F, and RF,PORT RF.nTTFST
1j Chaffee County
iI-1978-192
Pit No 6
June 30, 2006
$281.00 (Due on or before your anniversary date) °nd6eotnBy
Chaffee
R~~~p ` V M
~i~ision of
Minorots
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 ynnr revised written annnal re,Pnrf and annnal rennrt main 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: Joe Nelson
Permittee Name: Chaffee County
Address: POB 699
Salida, CO 81201
Phone Number: [phone] ^ ~~
Fax Number: (719) 5~o-~2bg
If you have additional cormnents 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.
e of orporate Officer, Owner, or Designee
- 5 'o
Date
M:~PERMITV.IASTERDOCUMENTSM-AP-04 ~,