2003-01-06_REPORT - M2000149

• Permit No: M2000149
• IBM Index Class Name: Report
• Doc Date: 1/6/2003
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
JAN 0 6 2003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Todd K. Dysart
M-2000-149
Todd Dysart Pit
January 5, 2003
$281.00 (Due on or before your anniversary date)
Logan
Division ~f Minerals and Geolosy
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 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 attaches nor revised written anmral r~nrt and anmial report ma~to this form- 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: Todd K. Dysart
Permittee Name: Todd K. Dysart
Address: 1148] CR 370
Sterling, CO 80751
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 io this form along with your written report and map. Annual Report instructions are enclosed.
1 L~ G\ ~"7/~~
Signature of Corporate fficer, Owner, or Designee
l Z-- ,30 -_ a z--
Date
M 1PERMnVv1ASTERD000MENTSVv1-AF-01