REP19744

• Permit No: M1987023
• IBM Index Class Name: Report
• Doc Date: 3/29/2002
• Doc Name: 2002 Annual Report
• From: Ricky W Mitchell
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ECEIVED
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Ricky W Mitchell
M-1987-023
Mitchell Pit
March 31, 2002
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$281.00 (Due on or before your anniversary date)
Adams
According to C.R.S. 34-32.5-1 16 or C.R.S. 34-32-1 16, each year, on [he anniversary date of the permit, an operamr
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 annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and i~aaludes the above elements may suffice for a written report.
Division records indicate the following petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ricky W. Mitchell
Permittee Name: Ricky W Mitchell
Address: P.O. Box 10
Bennett, CO 80102
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach i[ to this form along with your written report and map. Aonua] Report instructions are enclosed.
~T~~• //G
Signatur Corporate Officer or Owner
~~~°~-
Date
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