2005-11-30_REPORT - M1984154

• Permit No: M1984154
• IBM Index Class Name: Report
• Doc Date: 11/30/2005
• Doc Name: Annual Fee/Report/Map
• From: City of Lamar
• To: DMG
• Media Type: D
• Archive: No

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ANNiIAi. FF.F. and RF.PnRT RF.t7iiF.ST
~/"L~n"' ~ ~ pirision of Minerals and GaolaBY
PERMITTEE NAME: 'City of Lamar
PERMIT NO.: (~1--1984-154
OPERATION NAME: Well Field Pit
ANNIVERSARY DATE: December 10, 2005
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Prowers
-" _ " Atcarding to,C-•.P.:S- 34-32:5-11G or C.R.S. -34-32-116,_each year,. on_tlte_annive_rsary date of th_e 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.
Please attach ymrr revised written anneal report and anneal report main, 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 petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Patrick Mason
Permittee Name: City of Lamar
Address: 102 E. Parmenter St.
Lamar, CO 81052-3239
Phone Number: [phone] ~ - "" -
Fax Number: [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 farm along with your written report and map. Annua] Report instructions are
enclosed.
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Signature of Corporate Officer, Owner, or Designee
~~-1O- 05
Date
M:IPERMINIASTERDOCUMEN7S~M-AF-04