REP27783

• Permit No: M1987023
• IBM Index Class Name: Report
• Doc Date: 4/1/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

V
RECEIVED
APR Q 11003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Ricky W Mitchell
M-1987-023
Mitchell Pit
March 31, 2003
$281.00 (Due on or before your anniversary date)
Adams
Division eI Minerals and Geelo~y
shall submit the annual tee, 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 yneer revised written annual reQnrt and annual re rro t mapjn this form. 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: Ricky W. Mitchell
Permittee Name: Ricky W Mitchell
Address: P.O. Box 10
Bennett, CO 80102
Phone Number: [phone]
Fax Number:
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 o orporate Officer, Owner, or Designee
3~~ ~o .3
Date
M:~PERM11lMASTERDOCUMENTSUI-A F-01