REP09339

• Permit No: M1977044
• IBM Index Class Name: Report
• Doc Date: 5/12/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

APR-23-03 11:03 FROF4-Colorado Division of fdinerals & Gaoloriy/ [phone] T-100 P.003/003
V
A TAT FFF and F.PORT RFOTlF.CT
RECEiVE®
PERMITTEE NAME_ Costilla County
PERMIT No.: i~[_1977-oaa MAY 1 2 2003
OPERATION NAME:
ANNP/ERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
F-178
Division of Minerals and Geology
Costilla Cnty Pit 1
February 25, 2003
$281.00 (pne on or before your anniversary date)
Cosiilla
According to C.RS. 34-32.5-116 or C.RS_ 34-32-116, each yeaz, 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, reclamation accomplished to date and during the preceding year, new disturbances that aTe anticipated to
occur doting the upcoming year, reclamation that will be performed during the corning year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attaeltynpr rcmced writt n ann . 1 rrnnrt and annna/ rr.>..rt .nan to thtc forrt~ Please note that an
adequately labeled map that c/early delineates and Includes the above elements may since for a written
report
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permirtee Contact: Elizabeth
PetmitteeName: Costil nun
Address: P .Box 100
~~Y~~ y~~oE~,
Cos'1'ih~A eout~~l-v
P.©, (fox ISO
Sou hu.~s Ca S~lls2,
San Luis, CO 81 ] 52
Phone Number: [phone]
Fax Number; [phone]
`'(iq-(a `lZ.`g10~1
`I t q - i:QY x. - 3003
I£ 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 trap. Annual Report instructions aze
enclosed.
G~~ v~~
Signature of Corporate Officez, Owner, or Designee
y /L`11o3
D1te
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