REP09017

• Permit No: M1983119
• IBM Index Class Name: Report
• Doc Date: 8/1/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Kiowa County
M-1983-119
Chivington Grazing
August 25, 2003
RECEIVED
auc o ~ 2003
Division ~I Minerals and Geology
$281.00 (Due on or before your anniversary date)
I{iowa
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 sir-Umit the a`nt3ual fee, a report and map showirig the exient 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 ym~r revised written annual rennr and anneal re~nrt man 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: Rodney Hopkins
Permittee Name:
Address:
Kiowa County
P.O. Box 100
Eads, CO 81036
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.
Signature of orporate ~ fficer, Owner, or Designee
?-a~~
Date
MiPERMITMASTERDOCUMENTSUI-AF-04