2003-10-07_REPORT - M2000050

• Permit No: M2000050
• IBM Index Class Name: Report
• Doc Date: 10/7/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

OCT 0 7 2003
Oivisien of Minerals and Geology
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Gail C. Allen and Millie J. Allen
M-2000-050
Broken Spear Pit
October 2, 2003
$281.00 (Due on or before your anniversary date)
Lincoln
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, _ _
rec amahon accomplished to date a~ during t e~ecudtng 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 anneal refit and anneal repot main to this fnrm_ 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: Gail C. Allen
Permittee Name: Gail C. Allen and Millie J. Allen
Address: 68075 CR 109
Phone Number:
Fax Number:
Genoa, CO 80818
[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 forth along with your written report and map. Annual Report instructions are enclosed.
~~~~iQ
Signature of Corporate Ot~icer, Owner, or Designee
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