2003-08-14_REPORT - M1984134

• Permit No: M1984134
• IBM Index Class Name: Report
• Doc Date: 8/14/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Prowers County
M-1984-134
Randy Shaw Pit
August 31, 2003
$688.00 (Due on or before your anniversary date)
Prowers
AUG 1 4 2U03
Division ~f Minerals and Geology
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
- operatoisshal~ snit the anneal fee, arep-tor and map showing the eztenf of current disturbahces to of of cite
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 annual report and anneal tenor[ mad 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: Mark Frowers
Permittee Name: Prowers County
Address: 109 E. Sherman St.
Lamar, CO 81052
Phone Number: [phone]
Fax Number: [phone]
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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.

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Signature of Corporate O cer, Owner, or Designee
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