2005-09-15_REPORT - M1980112

• Permit No: M1980112
• IBM Index Class Name: Report
• Doc Date: 9/15/2005
• Doc Name: Annual Fee/Report/Map
• From: Rio Blanco County
• To: DMG
• Media Type: D
• Archive: No

16-AUG-2005 10:30
FROM-Colorado Divicion of Minarafc i Gaolotp [phone]
PERMIT?EE NAME:
PERMIT No.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
AF r~Pi
Ri Blanco Connty T'1
//M-1980-712
Richard Bachman Pit
July 10,2005
T-344 P.002/002 F-T3T

9 is-Ds
$688.00 (Dne on or before your anniversary date)
Rio Blanco
According to C.R,S. 34-32.5-116 or C.RS. 34-32-116, each year, on the anniversary date of the permit, am
~ 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 prcecding 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.
Pleat aMa ynnr reviaed written anneal rennrf and annnal re ni rt main to hia Ynrm. PI¢aS¢ note tRat an
adequately labeled map that clearly delineates and irrcludac the above elements may suffice jor a written
reporl.
Division records indicxte the following permittee contact information. Please verify and make any necessary
changes:
Pemdttee Contact: Jetty-Steele
Perrnittec Name: Rio Blanco County
Address: 570 2nd St.
Meeker, CO 81641
Phone Number: (979}8-7$3601
Fax Number: [phone]
~~t"d P ~ ~r~
(~ ~ o) 87~_ 95gv
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. Annua] Report instructions are
enclosed.
Signature of Corporate fficer, Owner, or Designee
s/~~los
Dare
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