2006-08-30_REPORT - M1984140

• Permit No: M1984140
• IBM Index Class Name: Report
• Doc Date: 8/30/2006
• Doc Name: Annual Fee/Report/Map
• From: Prowers County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
'/
PERMITTEE NAME: Prowers County
PERMIT NO.: v M-1984-140
OPERATION NAME: Walker Pit North
ANNIVERSARY DATE: August 31, 2006
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Prowers
RECEIVED
/`~ AUG 3 0 2006
v OryMinin of Reclamation
9 and Safety
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
]and, reclamation accomplished'to date and during the preceding year; new disturbances that a>•e 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 vour revised written annual report and annual report map 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: Mark Dorenkamp
Permittee Name:
Address:
Phone Number:
Fax Number:
Prowers County
109 E. Sherman St.
Lamar, CO 81052
[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.
S(ig~nature of Corporate Officer, Owner, or Designee
b ~ ~'~~,
Date
M:IPERMI'IU1ASTERD000MENTSVM-AF-04