2004-08-19_REPORT - M1998065

• Permit No: M1998065
• IBM Index Class Name: Report
• Doc Date: 8/19/2004
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

. ~~
~ECEIVE®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Washington County
M-1998-065
Hayes Pit
September 18, 2004
AUG19~
Division of Minerals and GaoloOY
$281.00 (Due on or before your anniversary date)
Washington
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 shalt submit- the annual fee,-a reporf ana map showing the extent of current disturbances to affected
__~ land, reclama5on.accomplished-to.date-ard-during the-preceding year, new disturbancesihat are anticipated ro -
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 ynar revised written annnal re,~nrt and annnal re ran t man 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: Charles J. Kuntz
Permittee Name: Washington County
Address:
Phone Number:
Fax Number:
150 Ash
Akron, CO 80720
[phone]
[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 orate Offi r, Owner, or Designee
',~a-~~
Date
M:NERMITMASTEADOCUMENTS4M-AF-04