2001-11-13_REPORT - M1977098 ‎(2)‎

• Permit No: M1977098
• IBM Index Class Name: Report
• Doc Date: 11/13/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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III IIIIIIIIIIIIIIII
J'' ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Western Mobile Northern, Inc.
M-1977.098
Sievers Pit
November 15, 2001
$688.00 (Due on or before your anniversary date)
Ga~eld
REC~9a,~~
NOV i 3 ~~~1
Division of Minerals and Geology

According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he pernut. an operator
shall submit the annual fee, a report and trap showing the extent of current disturbances to affected land,
reclamation accomplished to date and' during the preceding year, new disturbances that ore anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning
of active operations, and [he date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual report map to this form. Plense note rhnr art
ndequntely lnbeled map that clearly delineates mtd inchtdes the above elements may suffice fora K•ritren report.
Division records indicate the following pentti[[ee contact information. Please verify and make any necessary
changes:
Permittee Contact: £-ttie-Resk~ntine ~lPz-Y T. TU7~'"(,t"
Permittee Name: Wes[em Mobile Northern, Inc.
Address: 1590 W. 12th Ave.
Denver, CO 80204
Phone Number: (303) 657' Y/~ 3
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 [o this form along with your written report and map. Annual Report instructions are enclosed.
Signature
Date

M1PERh1rM1ASTERD000M11Ef"ISN4-AF 01