2003-11-03_REPORT - M1983177

• Permit No: M1983177
• IBM Index Class Name: Report
• Doc Date: 11/3/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Bent County
M-1983-177
Adams Pit
November 2, 2003
$281.00 (Due on or before your anniversary date)
Bent
FiECE1vE®
NOV 0 3 ~
pivision ~1 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-submit-the_aanual_fee,a_repott-and-map~howing_Ihe_extent of_current disturbances. ta_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 attacJ~ymtr revised written annnal re~nrt and annnal rennrf ma+ M this fnrm_ Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gary Pritchard
Permittee Name: Bent County
Address: P.O. Box 3S0
Las Animas, CO 81054
Phone Number: __(719) 456-2223_ _
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.
Signatur f Corporate Officer, Owner, or Designee
/O- ot~-3.oa'~
Date
M iPERM ITM ASTERDOCl1M ENTSUI-AF-04