2003-01-17_REPORT - M1981158

• Permit No: M1981158
• IBM Index Class Name: Report
• Doc Date: 1/17/2003
• 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:
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-dafe.and during the preceding year, new.disturhances_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 ynnr revised written annnai rennrt and annnai report m sn 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 permittee contact information. Please verify and make any necessary
changes:
Permiuee Contact Dale Kortz
Permittee Name: Forest Lakes Metro District
Address:
Phone Number:
Fax Number:
Forest Lakes Metro District RECEeVE p
M-1981-158 fqN ~ 7
Forest Lakes Pit #1 Zfl~3
~i~ision o/Minerals and Geology
January 26, 2003
$281.00 (Due on or before your anniversary date)
La Plata
P.O. Box 440
Bayfield, CO 81122-0440
[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. /~
J
Owner, or Designee
i/13/o
M:~PERM771MASTERDOC UMENTSU1-AF-04