2006-11-13_REPORT - M1992113

• Permit No: M1992113
• IBM Index Class Name: Report
• Doc Date: 11/13/2006
• Doc Name: Annual Fee/Report/Map
• From: Bent County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
//sent county
M-1992-113
Verhoeff Pit No 2
December 17, 2006
RECEIUE~1
~ ~Inu •; :~ inns
t~Division of Reclamation,
Mining and Safety
$$688.00 (Due on or before your anniversary date)
Bent
- -- =-According_to_GR:S. 34-32-.5-1-16-or-G.R.S. 34-32-1-I6, each-year, on-the-anniversary-date-of-tire-p_ermit~_ J' --
ope~ator 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 aze 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 vour revised written annual report and annual report maa to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated maa. If no new disturbances or reclamation have occurred during the previous vear and no
new changes to the previous year's man are necessary, then no new map is required, nrovided that the
Operator shall state this in the Annual Resort. 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
Permittee Name:
Address:
Phone Number:
Fax Number:
Gary Pritchard
Bent County
P.O. Box 350
Las Animas, CO 81054-0350
[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.
Signature of Corporate Offic ,Own r, or Designe~
I ~ - o ~- o2.F~ o co
Date
MiPERMITMASTERDOCUMENTS4M-AF-04