2003-10-27_REPORT - M1978170

• Permit No: M1978170
• IBM Index Class Name: Report
• Doc Date: 10/27/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE;
COUNTY:
Delta County
M-1978-170
Ellison Pit
October 26, 2003
$688.00 (Due on or before your anniversary date)
Delta
~~nc p~rr"g1
OCT 21 2003
Disisian of Minerals and Geology
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 yr.nr revised written anneal rennrt and anneal re~nrt map to this form. Please note that an
adequately labeled map Yhat clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Larry Record
Permittee Name: Delta County
Address: 501 Palmer St., Ste. 227
Delta, CO 81416
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 map. Annual Report instructions are
enclosed.
~ -.~ ~ ~~-~ /, d~,
Signature o~Lorpor' ante 'facer, w , V rgnee
i~o~~
Date
M:~PERMITU-tASTERDOCUM ENTSVv1-AF-04