REP15011

• Permit No: M1981220
• IBM Index Class Name: Report
• Doc Date: 12/26/2002
• Doc Name: 2002 Annual Report
• From: San Miguel County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE;
COUNTY:
ANNUAL FEE and REPORT REQUEST
San Miguel County
M-1981-220
Klonrlike Pit
November 20, 2002
$685.00 (Due on or before yow anniversary date)
San Miguel
RECEf VEp
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Division nt Minerals and Gealagy
According to C.R.S. 3432.5-I16 or C.R.S. 34-32-I16, 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 yeaz, new disturbances that aze anticipated to
occur during the upcoming yeaz, 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 yeaz, if any.
Please attach vour revised written annual report and annual report map 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: Mike Homer
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
Phone Number: [phone]
Fax Number: [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 trap. Annual Report instructions aze
enclosed.
Sf~gtature of Corporate Officer, Owner, or Designee
//- y ~
Date
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