2006-11-17_REPORT - M1985129

• Permit No: M1985129
• IBM Index Class Name: Report
• Doc Date: 11/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
/ ANNUAL FEE and REPORT REpUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
`~/ Elbert County
r/ M-1985-129
Elbert County Pit
November 25, 2006
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RECE~yED
`~ NOV 17 2p06
/t)ivMinj °f Reclamation,
n9 and Safety
$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 anniversarydate of the pennies 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 vour revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated moo. If no new disturbances or reclamation have occurred durinc the previous vear and no
new chances to the previous year's map are necessary, then no new man is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled Wrap 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: Rick Manyik
Permittee Name: Elbert County
Address: P.O. Box 116
Phone Number:
Fax Number:
Kiowa, CO 80117
[phone]
[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.
/~ o. ~ , D
Signature of Corlforate OffiBer, Owner, or Designee
Date
-n_
M:~PERMITNIASTERDOCUMEMSUI-AF-04