2005-11-04_REPORT - M1981220

• Permit No: M1981220
• IBM Index Class Name: Report
• Doc Date: 11/4/2005
• Doc Name: Annual Fee/Report/Map
• From: San Miguel County
• To: DMG
• Media Type: D
• Archive: No

~'Cp ~
~~ ~~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Sa~ Miguel County
t/M-1981-220
Klondike Pit
November 20, 2005
RECEIVE,
~OV 0 4 2005
Division of Minerals any veaiag y
$688.00 (Due on or before your anniversary date)
San Miguel
____ -According,to_GR~. 34-32Ss1-I6-or-G,R.S-3.4 32-1.16, each year;-on the anniversary-date-of-tl~e-peiinit; an-
-" "--operator "shall submit-the annual-fee; a report and map showing the extenC of current-disturbances to`affeoted"
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 ym~r revised written anmial repnrf and annnel repprf maT to this form. 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: Mike Horner
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
Phone Number: [phone]
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 to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of C rporate Oflicer, Owner, or Designee
Dates
MiPERMITN1ASTERDOCUMENTS~M-AF-04