REP08972

• Permit No: M1980003
• IBM Index Class Name: Report
• Doc Date: 2/3/2004
• Doc Name: Annual Fee/Report Notice
• From: Gary K. and Sarah L. McNulty
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

fl~
R CEIVED
FEB 0 4 2004
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Gary K, and Sarah L. McNulty
M-1980-003
McNulty Cinder Pit
January 23, 2004
$281.00 (Due on or before your anniversary date)
Eagle
Di>,isimi of Minei a~ 'v gam,
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,
-°-reclamatian-accomptishEd-to-date-and-durittg-the-preceding-year, new-disturbances-that-are-amicipated-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 annual rennrt and annual re rt man in 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: Sarah L. McNulty
Permittee Name: Gary K. and Sarah L. McNulry
Address: 7747 CR 100
Carbondale, CO 81623
Phone Number: [phone]
Fax Number: [phone]
5A ~~F t-l ~ . M ` of u t_ ~
~.42y lam. t ~'i~uz,a h L . ~ < ~u ~ ~ y
~~ 4-~ ~cso R J
`~(aue -i- ~a-K
'l v
If you have additional comments and/or information that should be provided to the Division, please provide i[
below or attach i[ to this form along with your written report and map. Annual Report instructions are enclosed.

Signature of Corporate Officer, Owner, or D@signee
211 l~~-
Data T
M:\PERM ITVNASTERDOCUM ENTSVN-AF-0I