2005-10-24_REPORT - M1978172

• Permit No: M1978172
• IBM Index Class Name: Report
• Doc Date: 10/24/2005
• Doc Name: Annual Fee/Report/Map
• From: Delta County
• To: DMG
• Media Type: D
• Archive: No

- ;
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~~`~I'I
~~^ m
ANNiJAI. FF.F, and RF.Pt1RT RF.OiJF,ST
RECEIVED
Delta County ~~~ ~ 4
~M-1978-172
Antelope Hill Pit
October 26, 2005
-f (} Division of Minerals ar,J Gaoloyy
$688.00 (Due on or before your anniversary date)
Delta
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 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 your revised written annnal rennrt and annnal report maw to this form- please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report. ~ ~ .~.~'t~CfL~ /17e41
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:
Fax Number:
[phone]
[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.
,% .~~ .~
of C rporate Officer, er, or Designee
Date
M:IPERMlTIMASTEROOCUMENTSNr-AF-04