2006-07-03_REPORT - M1984013

• Permit No: M1984013
• IBM Index Class Name: Report
• Doc Date: 7/3/2006
• Doc Name: Annual Fee/Report/Map
• From: George E. Otten
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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A1Y11A1. FF:F and REPORT RFnI!F4T •G'Y/ ~ /G~ ~~~~~
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PlERMITfEE NAME: •' George F:. Ottcn ~~,H
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PC•RMff NO.: / 11-19&i-013 °~.c,
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OI'L•RA'IION N:\ME: Mackey dine °r
ANNIVERSARY UA11i: ~fav 14. 2006
ANNUAI. PEE DI1L: 5225.00 (Due o0 or before your anniversary date)
COiINTY: Gilpin
Acrnrding to ('.R.S. 34-32.5-1I6 or <'.R.S. 34.32-I I6, each year, on the anniversary dote of the Ixnnn, an
operator shall submit the annual fee, a « {x'rt and rnap showing the extent of current disturbances to afl'uacJ
land, reclamation aceomplislnd to date and during the pnccding year, new disturbarnes that arc anpcipotcd to
occur durng the upcoming year, reclamatton that will be pcrfcxmed during the coming year, the dates for the
beginning of active operations, and the date active upemuons ceased for the year, if any.
Please arrach ~•nur rcvkeA written annnal rrnnrl and sonnet re rt m n to lhia form Please Wore fhcr! un
urleyuulvly luhrlrrl map lhuJ clearly delineale.~ Wart rnrludes !hc• abrnr clenum(e nulp suJ)ice Jirr a written
rcnarl.
I)ivrs+on records indicate the following pcrntittee contact information. Please vrnfy and make any necessary
changes:
Address: 1 1438 C'R 19
i
fort Lupton. C'O 80621
- Phone Nwnbcr: [phone]
•- fns Number [phone]
!f you have additional comments and/or mfnrnwGon that should be provided to the Division, plrrrsc provide it
•" below or attach it to this form along with your written report and map. Annual Report mstnrctinns a«
enclosed.
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`irgnawrr oLCorp rate Uflicer, (honer, or Designee
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Pcrmiitcc Contact: Cicorgc f Otten
Pcrntittce Name: George li. Otten ~%~