2003-09-15_REPORT - M1983130

• Permit No: M1983130
• IBM Index Class Name: Report
• Doc Date: 9/15/2003
• 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:
Al~'N11A7, FP,It and RF,PCIRT RF,OIIEST
Elbert County
M-7983-130
Nest Pit
September 22, 2003
RfCEBVED
SEP 1 5 2003
pirision ~f Minerals and Geology
$281.00 (Due on or before yom~ anniversary date)
Elbert
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 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.
Plearn attach your revised written annual re7rort and annnat re orp t man to this form. Please note lhaf an
adeguatel)~ labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Marilyn Sproch
Elbert County
809 Ute Ave.
Sun1a, CO 80835
rr~
Phone Number:
Fax Number:
[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.
~``- ~ - C s//~
Signature of C porate Of. cer, t;`Designee
~,, 02 k U 3 '_-
Date
M: V'ERMITMAS7ERD000MENTSVv1-AF-04