2002-01-14_REPORT - M1981158

• Permit No: M1981158
• IBM Index Class Name: Report
• Doc Date: 1/14/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

k -- r
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
III IIIIIIIII I'11111
;4NNUAL FEE and REPORT REQUEST
Forest Lakes Metro District
M-1981-158
Forest Lakes Pit #1
January 26, 2002
RECEfVED
JAN 1 4 2002

Division of Minerals and GeolollY
$281.00 (Due on or before your anniversary date)
La Plata
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 [he annual fee, a report and map showing [he extent of current disturbances [o 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, an~i the date active operations ceased for the year, if any.
Please attach your revised writt~zn annual report and annual report map to this form. Please mote that art
adequately labeled map. that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Dale Kortz
Permittee Name: Forest Lakes Metro District
Address: P.O. Box 440
Bayfield, CO 8 1 1 22-0440
Phone Number: [phone]
Fax 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.
1
Corporate O~ficer or Owner
~ 90Z
Date
A1:~PERMFMIASTER DOCUMENfSN1-AF-lll