2001-11-28_REPORT - M1987038

• Permit No: M1987038
• IBM Index Class Name: Report
• Doc Date: 11/28/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME;
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
III IIIIIIIIIIIII III
sss
ANNUAL FEE and REPORT REQUEST
Western Mobile Northern, Inc. ~ECEj,/ED
M-1987-038 N~~ 2
8 2~~~
Bayfield Pit No. 1 ~tviston of M(
November 15, 2001 nerals and Gealog~
$688.00 (Due on or before your anniversary date)
La Plata
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, 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 dis[uriiances that are anticipated to occur
during [he upcoming year, reclamation [hat will be performed during the coming year, [he 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 resort map to this form. Please note that an
adequately labeled map that clenr(y delineates and includes the above elements may since for n K•ritren report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Etic Reckentine
Pennittee Name: Western Mobile Northern, Inc.
Address: 1590 W. 12th Ave.
Denver. CO 80204
Phone Number: [phone]
Fax Number: [phone]
If you have additional cotTUnen[s and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written repott and map. Annual Report instructions are enclosed.
Signature of Corporate Officer or Owner
Date
h1:WERM111 IV.7ASTERD000MENTSU1-AF 01