REP09776

• Permit No: M1983130
• IBM Index Class Name: Report
• Doc Date: 9/3/2002
• Doc Name: 2002 Annual Report
• From: Elbert County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Elbert County
M-1983-130
West Pit
September 22, 2002
$281.00 (Due on or before your anniversary date)
Elbert
RECEIVED
SEP 0 3 2002
Division of 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
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 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 your revised written annual report and annual report map to this form. Please note tl~az an
adequately labeled map that clearly 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:
Permittee Contact: Marilyn Sproch
Permittee Name:
Address:
ANNUAL FEE and REPORT REQUEST
Elbert County
809 Ute Ave.
Simla, CO 80835
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments andJor 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 Corpgl`ate Officer, Owner, or Designee
G
Date
M:IPERMI7lMASTERD000MENTSV.I-AF-04