REP09908

• Permit No: M1992038
• IBM Index Class Name: Report
• Doc Date: 9/2/2004
• Doc Name: Annual Report and Fee
• From: Sand Creek Farms Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME: Sand Creek Farms, Inc. REC+EI~E:®
PERMIT NO.: M-1992-038 SEP 0 2 2004
OPERATION NAME: Sand Creek Mine
Division of Minerals and Geology
ANNIVERSARY DATE: September 1, 2004
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Adams
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,
rec[am`ation accompli"shed-to date and during the preceding year; new'disturba'nces`tFiat 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 anneal re~nrt and anneal re~grt man to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Wayne Pipkin
Sand Creek Farms, Inc.
P.O. Box 404
Byers, CO 80103
[phone]
[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.
?n
Signature of rp at f cer, Owner, or Designee
Date