2007-09-18_REPORT - M1977075

• Permit No: M1977075
• IBM Index Class Name: REPORT
• Doc Date: 9/18/2007
• Doc Name: Annual Fee/Report/Map
• From: Holyoke Gun Club
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

AF ~-Re~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Holyoke Gun Club
M-1977-075
Holyoke Gun Club Pit
September 27, 2007
RECEIVED
SEP 18 2007
Dlvlelon of ReGamatbn,
Mining and Safety
$$323.00 (Due on or before your anniversary date)
Phillips
According to C.R.S. 34-32.5-I 16 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,
---- - recta*nation-accomplished to-date-and-durinprth~pseceding~earYnew-disturbances-thaCare_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 your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred durin¢ the previous year and no new changes to
the previous year's map are necessary, then no new maa is required, provided that the Operator shall state
this in the Annual Report. 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 following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Sr~lt
1\DSS ~~ ~h~~et,~c,
Permittee Name:
Address:
Holyoke Gun Club
20358 CR 45
Holyoke, CO 80734-9507
Phone Number: [phone] ~ ~(7 ~ `gS ~ - J 3 i j
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.
Si ature o Corporate Officer, Owner, or Designee
Date