2004-04-05_REPORT - M1979103

• Permit No: M1979103
• IBM Index Class Name: Report
• Doc Date: 4/5/2004
• Doc Name: Annual Fee/Report/Map
• From: Diana K. Watson
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEI!/ED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Diana K. Watson
M-1979-103
Amick Pit
Apri18, 2004
APR 0 5 2004
Division of Minerals & Geology
$281.00 (Due on or before your anniversary date)
13io Blanco
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 r~pprt a_nd ma~bmuing_the.-_eactent_of._curxent_disturbances-to-affected land, -
reclamation accomplished to date and during the preceding 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 ynnr revised written anmial rennet and annnal red net man to this form- 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: Diana K. Watson
Pennittee Name:
Address:
Phone Number:
Fax Number:
Diana K. Watson
P. O. Box 1056
Meeker, CO 81641
[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.
Signature of Corporate Officer, Owner, or Designee
Date