2005-02-16_REPORT - M1990131

• Permit No: M1990131
• IBM Index Class Name: Report
• Doc Date: 2/16/2005
• Doc Name: Annual Fee/Report/Map
• From: Ricky W. Mitchell
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
FEB 16 2005
Division ~f Minerals and GeoloBY
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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,
-- reclaration accomplished-to-date-and-during-the precedmgyear; rrew~listarbances thatare-antieipated-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 anmial re~nrt and annual report mad to Chic form. Pease note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Ricky W. Mitchell
M-1990-131
Mitchell Pit #2
February 14, 2005
$281.00 (Due on or before your anniversary date)
Adams
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Ricky W. Mitchell
Ricky W. Mitchell
Permittee Name:
Address:
Phone Number:
Fax Number:
P.O. Box 10
Bennett, CO 80102
[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.
Signature of C orate Officer, Owner, or Designee
oZ~le~DS
Date