2006-05-05_REPORT - M1983039

• Permit No: M1983039
• IBM Index Class Name: Report
• Doc Date: 5/5/2006
• Doc Name: Annual Fee/Report/Map
• From: Las Animas County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~U
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
i/ ANNi1Ai. FF.F, and RF,PORT RF.nfTFST
f/ Las Animas County
~M-1983-039
Airport Gravel Pit
Apri128, 2006
~ MAY 05 20Q6
/Diataiso of Mlnarala and Deologr
$688.00 (Due on or before your anniversary date)
Las Animas
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
__ operato;_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 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 attachwnur revised written annual report and annnal re,Pnrt main 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: Phil Dorenkamp
Permittee Name: Las Animas County
Address: 2000 N. Linden Ave.
Trinidad, CO 81082
Phone Number:
Fax Number:
If voG ha
getow or
enclosed.
Date
[phone]
[phone]
Tonal comments and/or information that should be provided to the Division, please provide it
it to this form along with your written report and map. Annual Report instructions are
M:~PERMIT\MASTERDpCUMEMSNI-AF-0O