REP44992

• Permit No: M2001019
• IBM Index Class Name: Report
• Doc Date: 6/11/2002
• Doc Name: 2002 Annual Report
• From: Bent County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Bent County
M-2001-019
Bent County Pit # 2
June 22, 2002
$688.00 (Due on or before your anniversary date)
Bent
RECEI~9ED
JUN 1 1 2002
Division of Minerals and Geology
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
s all 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 tlia't 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 resort and annual report map to this form. Please note that an
adegaate[y 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: °^~° n°-'°Il
Permittee Name:
Address:
Ben[ County
P.O. Box 350
Las Animas, CO 81054
Phone Number: [phone]
Fax Number: [phone]
~D gfL~I L . -P RS'rc Hg R o
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.
""`~~
Signat`yrof Corporate Officer or Owner
Date
M:IPERMmMASTERD000MENTSVA-AF-01