REP34054

• Permit No: M1978107
• IBM Index Class Name: Report
• Doc Date: 10/21/2002
• Doc Name: 2002 Annual Report
• From: Montezuma County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Montezuma County
M-1978-107
Tozer Pit
November 2, 2002
RECEIVED
OCT 2 1 2002
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Montezuma
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, reclamation accomplished-to-date~and duringthe~preceding year,-new-disturbances that are anticipated-to - - -
occur during [he upcoming year, reclamation that will be performed during [he coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map 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: Lloyd Everett
Permittee Name: Montezuma County
Address: 1680 Hwy. 145
Phone Number:
Fax Number:
Cortez, CO 81321
[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 form along with your written report and map. Annual Report instructions are
enclosed.
gnature d Corporate Officer, Owner, or Designee
/6~~/~ ~
Date

M iPERM nN9ASTERD000MENTSVN-AF-04