REP17195

• Permit No: M1987019
• IBM Index Class Name: Report
• Doc Date: 3/13/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
MAR 1 3.2003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
S.
an
operator shall submit the annual fee, a report and map showing the extent of current disturbances to atfected
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 yty~r revised written anneal rennrt and anneal rennrt mare to this form. Please note that an
adequately labeled map that 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: Lawrence "Buddy" Shaver
Permittee Name:
Address:
Rio Grande County
168 N. Washington
Monte Vista, CO 81144
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.
Signature of Corporate Officer, Owner, or Designee
Dat- e
Rio Grande County
M-1987-019
South Fork Pit
March 25, 2003
Division ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
Rio Grande
M:NERMIi1MASTER DOCUMENTSVN-AF-04