REP02853

• Permit No: M1977071
• IBM Index Class Name: Report
• Doc Date: 4/14/2003
• Doc Name: Annuual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lake County
M-1977-071
Half Moon Pit
May 25, 2003
$688.00 (Due on or before your anniversary date)
Lake
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 fo-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 your revised written annual report and annual report main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: ~il~sk~-~ ~~r~ry ~Q ti ~ 4
Permittee Name: Lake County
Address: P.O. Box 964
Leadville, CO 80461
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.
Signature of Corporate fficer, Owner, or Designee
-f1-O
Date
M:IPERM ITN1ASTER DOCUMENTSVN-AF-04