2007-10-31_REPORT - M1983178

• Permit No: M1983178
• IBM Index Class Name: Report
• Doc Date: 10/31/2007
• Doc Name: Annual Fee/Report/Map
• From: Bent County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Bent County ~/
M-1983-178 /
Bent County Pit
November 2, 2007
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2'~0 ~fR lz~O ~ 0
saoa ciao ~,/
$$791.00 (Due on or before your anniversary date)
Bent
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
- - - ]and,-reelamation-accomplished to-date and-dtuing_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 vour revised written annual resort and annual resort mao to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated maa. If no new disturbances or reclamation have occurred durinti the arevious year and no
new chanties to the previous year's mao are necessary. then no new maa is required, urovided 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: ~axc.).'.~iteherd
Pennittee Name:
Address;
Bent County
P.O. Box 350
Las Animas, CO 81054
Phone Number: [phone]
Fax Number: [phone]
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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 Corporate Officer, O er, or Designee
./o _ ~3 -.a.oe~ `y
Date
M:~PERMIT~IvfASTERDOCUMEMSU4-AF-04