2001-11-19_REPORT - M1978107

• Permit No: M1978107
• IBM Index Class Name: Report
• Doc Date: 11/19/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
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ANNUAL FEE and REPORT REQUEST
Montezuma County
M-1978-107
Tozer Pit
November 2, 2001
RECEIVED
NOV 19 1001
Uiuision of Minerals and Ceolegy
$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 during the preceding year, new disturbances [hat are anticipated to
occur during [he upcoming year, reclamation that will be performed during the coming year, the dates for [he
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual resort map to this form. Please note that an
adequately Inbeled nrap that clearly delineates and includes the above elements pray suffice for a written
report.
Division records indicate [he following permi[[ee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lloyd Everett
Permittee Name: Montezuma County
Address: 1680 Hwy. 145
Cortez, CO 81321
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide i[
below or attach it [o this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer or Owner
Dale

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