2007-08-02_REPORT - M2006010 - Laserfiche WebLink

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!/~/ ~~( ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: CIS Forest, LLC t`~i PERMIT NO.: ~M-2006-010 ,J OPERATION NAME: MSF/Feister Pit #1 ~ AUG ~ 2 200) ~Nision of Rya ~ ~ ANNIVERSARY DATE: August 9, 2007 M~n9 end gy ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) COUNTY: Las Animas 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 of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual resort and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated man. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to the previous year's moo are necessary, then no new man is required, provided that the Operator shall state this in the Annual Report. 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: Mary Shaw Cando Permittee Name: Address: Phone Number: MS Forest, LLC President P.O. Box 521 Aguilar, CO 81020 (719)738-2014 Fax Number: (719) 738-6083 If you have additional coma below or attach it to this form Signature information that should be provided to the Division, please provide it 'our written report and map. Annual Report instructions are enclosed. Owner, or Designee Date