2003-09-19_REPORT - M1991081

• Permit No: M1991081
• IBM Index Class Name: Report
• Doc Date: 9/19/2003
• 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:
Charles Bud Keeling
M-1991-081
Keeling Pit
September 23, 2003
SEP 19 2003
Division ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
Huerfauo
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-accomp?tshed-te-date-and-daring-the-preceding-year-n~v:-disturbances-that-ere anticipated-to-eeeur -
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 annual rennrt and anmral rennrt m~ fn 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:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Sam M. Keeling Jr
Charles Bud Keeling
P.O. Box 361
LaVeta, CO 81055
[phone]
Ifyouu 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 Officer, O ier, or Designee
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