2001-12-17_REPORT - M2000149

• Permit No: M2000149
• IBM Index Class Name: Report
• Doc Date: 12/17/2001
• 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:
RECEIVED
ANNUAL FEE and REPORT REQUEST
Todd K. Dysart
M-2000.149
Todd Dysart Pit
January 5, 2002
III IIIIIIIIIIIIIIII
999
DEC 17 2001
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Logan
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished-to datz and during the preceding year,-new disturbances [hat are anticipated to occur
during the upcoming year, reclamation [hat 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 vour revised written annual report and annual resort map 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 permi[[ee contact information. Please verify and make any necessary
changes:
Permittee Contact: Todd K. Dysart
Permittee Name: Todd K. Dysart
Address: 11481 CR 370
Sterling, CO 80751
Phone Number: [phone]
Fax Number:

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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 O icer or Owner
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Date
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