2004-06-17_REPORT - M1981256

• Permit No: M1981256
• IBM Index Class Name: Report
• Doc Date: 6/17/2004
• Doc Name: Annual Fee/Report/Map
• From: Yuma County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNi¢ iAi. FF,F, and RF.PnRT RF, i1F.ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Yuma County
M-1981-256
Ekberg Pit
June 30, 2004
$688.00 (Due on or before your anniversary date)
Yuma
RECEIVED
JUN 17 Zppq
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 shall submit the annual fee, a report and maw showing the extent of current disturbances to_affected _ -__
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 ynnr revised written annnal re~nrt and annnal re~nrt main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the foliowing permittee contact information. Please verify and make any necessary
changes:
Pennittee Contact: Paul Like
Permittee Name: Yuma County
Address: 1310 S. Blake St.
Phone Number:
Fax Number:
Wray, CO 80758
[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 Corporate Officer, Owner, or Designee
S -/o
Date
M:~PERMITNIASTERDOCUMENTS~h1-AF-04