2007-07-12_REPORT - M1995034

• Permit No: M1995034
• IBM Index Class Name: Report
• Doc Date: 7/12/2007
• Doc Name: Annual Fee/Report/Map
• From: Daniel M Russell
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

/Pl ~
ANI~~F~El: an~ ~ PORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ Daniel M Russell
~/ M-1995-034
Bachus Pit
Jnly lo, 2007
R~C~6~~~p~ (~/
4J
~IJUL Y 2 2007
Division of Recian,a~,u,,,
~i4lining and Safety
$$688.00 (Due on or before your anniversary date)
Alamosa
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
shalt-submit-the`a~mual-fez,-a-report-an~map-showing-the'eactent~f c~trren['disturl5ances 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.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, resort, and associated
map. If no new disturbances or reclamation have occurred durine the previous year and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. 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: Daniel M. Russell
Permittee Name: Daniel M Russell
Address: 9042 S. 106 Rd.
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be
below or attach it to this form along with your written report and map.
Signature of Co porate O ficer, Owner, or Designee
provided to the Division, please provide it
Annual Report instructions are enclosed.
Date