2003-09-23_REPORT - M1977075

• Permit No: M1977075
• IBM Index Class Name: Report
• Doc Date: 9/23/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Holyoke Gun Club
M-1977-075
Holyoke Gun Club Pit
September 27, 2003
RECEIVED
SEP 2 3 2003
Division ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
Phillips
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 I
_shall_submit_the_annual_fee,_a_report_and map chowin~the-extent-of-surseni-disturbances to-affected-la:.d,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur I
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 annnal report and annnal report man 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: Gary Hershfeldt
Permittee Name: Holyoke Gun Club
Address: 20358 CR 45
Phone Number:
- Fax Number:
Holyoke, CO 80734-9507
[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 of Corporate Officer, Owner, or Designee
~~ ~
Date
M:~PERMITMASTERD000MENTSU1-AF-OI