2003-06-23_REPORT - M1984044

• Permit No: M1984044
• IBM Index Class Name: Report
• Doc Date: 6/23/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Saguache County
M-1984-044
San Isabel Pit
June 11, 2003
JUN 2 3 2003
Division ~f Minerals and Geology
$688.00 {Due on or before your anniversary date)
Saguache
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
an , rec ama ton accomp is a to ate an unng t e prece mg 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 annnal rennrt m ~n to this form- P/ease note that an
adequately labeled map that clearly delineates and includes [he 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: John Ungefug
Permittee Name: Saguache County
Address: Road and Bridge
P.O. Box 476
Saguache, CO 81149
Phone Number. (-7-19)-655-2554
Fax Number: [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.
.~
Signa tre of Corporate tcer, w er, or Designee
~~~g l~3
Date
M iPERMINIASTERDOCUMENTSUI-AF-04