REP27067

• Permit No: M1983039
• IBM Index Class Name: Report
• Doc Date: 4/25/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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I EE NAME:
O.:
~. It>N NAME:
' KSARY DATE:
L FEE DUE:
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Las Animas County RECElVE®
M-1983-039
Airport Gravel Pit APR 2 5 2003
April 28, 2003 division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Las Animas
to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the petnut, an _ ._
-,hall submit the annual fee, a'report' and map showing the extent of current disturbances to affected
i.unation accomplished to date and during the preceding year, new disturbances that are anticipated to
in~~ the upcoming year, reclamation that will be performed during the coming year, the dates for the
~~t active operations, and the date active operations ceased for the year, if any.
Ur~~~h ynnr revised written anm~al report and annn9l re nn rt map,jn this form. Please note that an
/ubeled map that clearly delineates and includes the above elements may since jor a written
~~~cords indicate the following permittee contact information. Please verify and make any necessary
Contact Phil Dorenkamp
Vame: Las Animas County
2000 N. Linden Ave.
Trinidad, CO 81082
,amber: [phone]
nh~r: [phone]
;icc additional comments and/or information that should be provided to the Division, please provide it
~r ;utach it to this form along with your written report and map. Annual Report instructions are

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