REP30460

• Permit No: M2000018
• IBM Index Class Name: Report
• Doc Date: 6/2/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

J
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Cheyenue County
M-2000-018
Munsch Pit
May 2, 2003
RECE~VE~
JUN n 12003
~~~1S7en of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Cheyenne
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
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 a a h ynnr revised written anneal renTrf and anneal rennrf m =n to 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: Lara Crowell
Permittee Name: Cheyenne County
Address: P.O. Box 567
Cheyenne Wells, CO 80810
Phone Number: [phone]
Pax Number: [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 orporate Officer, Owner, or Designee
sl 2/a '~
Dat
M'.~PERMITUv1A5TERDOCUMENTSti7-AF-n4