2001-04-16_REPORT - M1979103

• Permit No: M1979103
• IBM Index Class Name: Report
• Doc Date: 4/16/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

•
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~,
ANNUAL FEE and REPORT REQUEST
Darryl D. Stout
M-1979-103
Amick
April 8, 2001
III IIIIIIIIIIIII III
999
RECEIVED
APR 1 6 2001
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Rio Blanco
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 vour revised written annual report and annual report map to this form. Please note [ho[ an
ndeq+urtely labeled map [hat clearly deln:ea[es 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: Darryl Stout ,~~ `(~ja ~ ~ ~ncril-
Permittee Name: Darryl D. Stout cL7it~+~~ 7) ~'fyu7r-
Address: P.O. Box 1056
Meeker, CO 81641
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.
c-7 ~Get~ ~~~~~~~
ignature orpo`rate Officer or ner
Date
M ~PERMIPMP.STERDOCUMEMSVvi-AF-01