2002-01-24_REPORT - M2000115

• Permit No: M2000115
• IBM Index Class Name: Report
• Doc Date: 1/24/2002
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

ANNUAL FEE and REPORT REQUEST
Mullett's Excavating, L.L.C.
M-2000-115
Mulletts Excavting Pit # 1
January 29, 2002
RFCF~V~~
ol~l • AN ~ 4 ?00?
sroo ejNligerels dndCeplogy
$688.00 (Due on or before your anniversary date)
Las Animas

According [o 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 ais[urbances that are anticipated [o 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 map to this form. Please dote that an
adequately labeled map that clearly delinentes and includes the above elements Wray since for n written report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Pernti[tee Contact: Myron Mullett
Permit[ee Name: Mu1letPs Excavating, L.L.C.
Address: P.O. Box 322
Westcliffe. CO 81252-0322
Phone Number: [phone]
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.
.!:~~f
Si tre of Corporate Officer or Owner
TQhu~.,.. s ~ aoo1
Date
A1. W ER M n Vv1 ASTE R D OC U Al ENTS V.1-A F-01