2005-10-06_REPORT - M1980038

• Permit No: M1980038
• IBM Index Class Name: Report
• Doc Date: 10/6/2005
• Doc Name: Annual Fee/Report/Map
• From: Ron Ebberts
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
!-F ~ F
~i
R n Ebberts -f'~
1980-038
Disappointment Valle
October 1, 2005
RECEIVE
~CT Q's
r Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
San Miguel
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 your revised written annnal report and annual r~ r~ t map, to this trnrm_ Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice far a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ron Ebberts
Permittee Name:
Address:
Phone Number:
Fax Number:
Ron Ebberts
P.O. Box 250
Egnar, CO 81325
[phone]
[phone]
If you have addifional 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

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Date