2004-06-24_REPORT - M1977500UG

• Permit No: M1977500UG
• IBM Index Class Name: Report
• Doc Date: 6/24/2004
• Doc Name: Annual Fee/Report/Map
• From: Russell D Neesham
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVE
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Russell D Newham
M-1977-500-UG
Peggie Mines
June 29, 2004
$225.00 (Due on or before your anniversary date)
Montrose
JUN 2 4 2004
Division at Mia:.~" , tzvoioAY
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
---Ian ,reclamation aceomp i`shed-to o`ate and`durin~ [be ~re~dii~g-y~at; ~icw-disturbances-that-arc :.nt:.,ipated-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 ynnr revised written annual reRnrt and annnal rennrt mil to this form. Please note that an
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: Russell D. Newham
Permittee Name: Russell D Newham
Address: P.O. Box 314
Nucla, CO 81424-0314
Phone Number: [phone]
Fax Number:
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.
Signature of Corporat~ ~ficer, Owne gnee
~//ice o_ ~7~ ~Y'
Date
M:~PERMI7~MASTEADOCUMENTS/M-AF-02.DOC