2005-01-12_REPORT - M1983148

• Permit No: M1983148
• IBM Index Class Name: Report
• Doc Date: 1/12/2005
• Doc Name: Annual Fee/Report/Map
• From: Montrose 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:
Montrose County
M-1983-148
Neal Pit
January 30, 2005
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JAN 1 2 ?C~5

$688.00 (Due on or before your anniversary date)
Montrose
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 currentdisturbances_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 anneal rennrt and anm~al report map to 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: Brian Wilson
Permittee Name: Montrose County
Address: 161 S. Townsend
Montrose, CO 81401
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.
~r,
Stgn a of Corporate Officer, Owner, or Designee
Date
M:IPERMI7IMASTERDOCUMENTSU~I-AF-04