2006-01-18_REPORT - M1977534

• Permit No: M1977534
• IBM Index Class Name: Report
• Doc Date: 1/18/2006
• Doc Name: Annual Fee/Report/Map
• From: City of Golden
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~'F`;;~h~VED
J,~N 1 8 2006
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
City of Golden
M-1977-534
Empire Pit
January 30, 2006
Oivis,,... _. ,..,aerals and Geology
$688.00 (Due on or before your anniversary date)
Clear Creek
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`extenf of ouirent 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 your revised written anneal report and anneal 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 the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Dan Hartman
Permittee Name: City of Golden
Address: Director of Public Works
911 Tenth St.
Phone Number:
Fax Number:
Golden, CO 80401
[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.
SC.~~
Signature of Corporate Officer, Owner, or Designee
.~
Dale
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