2001-11-13_REPORT - M1983013

• Permit No: M1983013
• IBM Index Class Name: Report
• Doc Date: 11/13/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

Y ~ r
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
III IIIIIIIIIIIII III
ANNUAL FEE and REPORT REQUEST
RECEIVED
Western Mobile, Inc. NOV 13
M-1983-013 2UUI
Latham -Burkett Pit
November 15, 2001
Division of Minerals and GeoloBY
$688.00 (Due on or bet'ore your anniversary date)
Mesa
According to C.R.S. 34-32.5-I I6 or C.R.S. 34-32-1 l6, 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 [o occur
during the upcoming year, reclamation that will be performed during [he coming year, the dates for [he beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual resort map to this form. please mote tlrnt nti
ddequate[v labeled reap that clearly delineates and includes the above elements may since for a k•rirten report.
Division records indicate the following permi[[ee contact information. Please verify and make any necessary
changes:
G>~yTTv~ E
Permittee Contact: 6tae-R~Rtfle_
Permittee Name
Address:
Phone Number:
Fax Number:
If you have additional comments and/or information [hat should be provided [o the Division, please provide it
below or attach i[ to this form along with your written report and map. Annual Report instructions are enclosed.
Signatur f orate Officer or O ner
Date f ` ~~ /
Western Mobile, Inc.
1590 W. 12th Ave.
Denver, CO 80204
[phone]
M ~PERMrM1ASTERD000MEm'SU1-AF-01