2005-11-25_REPORT - M1988101

• Permit No: M1988101
• IBM Index Class Name: Report
• Doc Date: 11/25/2005
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DMG
• Media Type: D
• Archive: No

{F ;~ PT
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
' E/lbert County
vM-1988-101
Fondis Pit
December 15, 2005
Asw
REGE~®~E~;
~FIOV 2 52005
~ivisiun of fVlinetsls z.,.: :, z!sogp
$688.00 (Due on or before your anniversary date)
Elbert
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 date and during the preceding year, new disturbances that are anficipated to
occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attachynnr revised written annnal re;gpa't and anm,at re_pnrt man to this fr.rm_ Please note that an
adequately labeled map that clearly delineates and includes the 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:
Pemrittee Name:
Address:
Phone Number:
Fax Number:
Marilyn Sproch
Elbert County
809 Ute Ave.
Simla, CO 80835
[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
ignature of Corporate fficer, O esignee
Date

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