2005-06-30_REPORT - M1986074

• Permit No: M1986074
• IBM Index Class Name: Report
• Doc Date: 6/30/2005
• Doc Name: Annual Fee/Report Notice
• From: kym a schure
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
ANNilAi. FF.F, and RF,PnRT RF.QjTFST
~Kym A. Schure
fNI-1986-074
Dollerschell Pit
June 30, 2005
- -COUNTY: - - - - Logan - - -- - ----- - -- --- - - - -
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 ynnr revised written anmral report and anmral retort marn to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee 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:
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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. Annua] Report instructions are enclosed.
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Signature.g Corporate fficer, Owner, or Designee +
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Date
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$281.00 (Due on or before your anniversary date)