REP15094

• Permit No: M1985129
• IBM Index Class Name: Report
• Doc Date: 10/16/2003
• Doc Name: 2003 Annual Report and Fee
• From: Elbert County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RE~EIVE~
OCT 16 2003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Elbert County
M-1985-129
Elbert County Pit
November 25, 2003
$688.00 (Due on or before your anniversary date)
Elbert
Division of Minerals and Geology
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-submiEthe-anmial-fee,-a-report-and-map-showing-ihe-extern-of-current-disturbances-to affected- -
]and, 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 yn rr revised written annual r~nrt and annual re nrt m n to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: `fodd~amer-
Permittee Name: Elbert County
Address: 216 Cheyenne
P. O. Box 116
Kiowa, CO 80117
-Phone-Number:- -f363}6.2~3~Sfr'-_ - - - --- --
Fax Number: [phone]
IoN! 1" ~1FU1F L
Et=gF1~r ~oun-r`J
a i~ (~~-I>~ ~v n- E
PO Qox lll~
~~oulA CO ~ 0117
3o3-dal-3~s7.- ----- --- - ---I
303-~a (-3(_59
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 Corporate Officer, Owner, or Designee
C~rObt~ 7 aoG>`~
Date ~
M:~PERM I7~MASTERD000M ENTSVN-AF-04