2007-03-30_REPORT - M1987023 - Laserfiche WebLink

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j-~ °>~~ 1 ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Ricky W. Mitchell M-1987-023 Mitchell Pit March 31, 2007 RECEIVED MAR, 30 2001 pivision of Reclamation, Mining and Safety $$281.00 (Due on or before your anniversary date) Adams 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 reporE 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 your revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee. report, and associated mag. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to the previous year's map are necessary, then no new man is required, provided that the Operator shall state this in the Annual Report. 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: Ricky W. Mitchell Permittee Name: Address: Ricky W. Mitchell P.O. Box 10 Bennett, CO 80102 Phone Number: (303) 644-4102 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 Co rate Officer, Owner, or Designee ,3~ 4/07 Date