2004-06-30_REPORT - M1986074

• Permit No: M1986074
• IBM Index Class Name: Report
• Doc Date: 6/30/2004
• Doc Name: Annual Fee/Report/Map
• From: Kym A. Schure
• To: DMG
• Media Type: D
• Archive: No

U ~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Kym A. Schure
M-1986-074
Dollerschell Pit
June 30, 2004
$281.00 (Due on or before your anniversary date)
Logan

REr~fi~~~~
JUN 3 0 2004
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
ahall cnhmit the attnual fee a renort and map show~~ 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 ynnr revised written anm~al renort and anm~al report main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Kym A. Schure
Permittee Name: Kym A. Schure
Address: 12826 CR 37
Sterling, CO 80751
Phone Number: [phone]
Fax Number:
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.
Signa a of Corporate Officer, Owner, or Designee
Date