2005-04-01_REPORT - M1987023

• Permit No: M1987023
• IBM Index Class Name: Report
• Doc Date: 4/1/2005
• Doc Name: Annual Fee/Report/Map
• From: Ricky W Mitchell
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVE®
APR Q 1 "1005
PERMITTEE NAME:
PERMIT NO.;
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Ricky W. Mitchell
M-1987-023
Mitchell Pit
March 31, 2005

Oirisioa oFM'nerats and GaoloAY
$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 report and map showing the extent of current disturbances_to affected land,
- reclamation`accompilshe3 iodate 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 ynnr revised written annual rennet and anmial re~nrf man fn this form. Please note that an
adequately dabeled 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:
Permittee Name:
Address:
Ricky W. Mitchell
Ricky W. Mitchell
P.O. Box 10
Bennett, CO 80102
Phone Number: [phone]
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 ate Officer, Owner, or Designee
/~~~s
Date