REP10321

• Permit No: M1987023
• IBM Index Class Name: Report
• Doc Date: 4/1/2004
• Doc Name: 2004 Annual Report
• From: Ricky W Mitchell
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Ricky W Mitchell
M-1987-023
Mitchell Pit
March 31, 2004

RECEIVE®
APR 0 1 20~?4
Oivisian ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
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,
reclamation aocamplished-to-date-and-during the preceding year,-new-disturbances-that-are-anticipatecLto_occur _ _
during the upcoming year, reclamation [hat will be performed during the coming year, the dates for [he beginning
of active operations, and the date acfive operafions ceased for the year, if any.
Please attach your revised written annnal re,Pnrt and annual tenor[ man 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Ricky W. Mitchell
Ricky W Mitchell
P.O. Box 10
Bennett, CO 80102
[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 Officer, Owner, or Designee
3~3o/©y
Date