2001-05-18_REPORT - M1978192

• Permit No: M1978192
• IBM Index Class Name: Report
• Doc Date: 5/18/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
MAY ; 8 20G1
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNlJAL FEE DUE:
COUNTY:
Chaffee County
M-1978-192
Pit No 6
June 30, 2001
iii iiiiiiiiuiiiiii
999
RECEIVEQ
Division of MineralS4rldGeology
$225.00 (Due on or before your anniversary date)
Chaffee
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 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 your revised written annual report and annual report maa to this form. Please note that on
adequately labeled map that clearly delineates and includes t{re above elements pray s: ffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Cheri Moore
Permittee Name: Chaffee County
Address: P.O. Box 699
Phone Number:
Fax Number:
Salida, CO 81201
[phone]
(7]9)539-7442
If you have additional comments and/or information [hat should be provided to the Division, please provide it
below or attach it to [his form along with your written report and map. Annual Report instructions are
enclosed.
v
Signatur o C orate Officer or Owner
.~-rl-~I
Date
M:~PERM ITN1A STE RDOCU M1tENT5UI-AF-04