2001-12-21_REPORT - M1980233

• Permit No: M1980233
• IBM Index Class Name: Report
• Doc Date: 12/21/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
999
ANNUAL FEE and REPORT REQUEST
Costilla County
M-1980-233
Costilla
December 11, 2001
$281.00 (Due on or before your anniversary date)
Costilla
RECEIVED ~`'
DEC 2 1 2001
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 map showing the extent of current disturbances to affected
land, i'eciamanon accomphshe~ to date andduring the preceding year, new disturbances [hat are anticipated io
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. Please note that an
adequately labeled map that clearly delineates mtd includes the above elements may since for a written
report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Permittee Con[acC Elizabeth Pacheco
Permittee Name;
Address:
Costilla County
P.O. Box 100
San Luis, CO 81152
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to [he Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
i~i gn re of Corporate Officer or Owner
,r0~?, /Tao i
Date
M:~PERM rfN1A5TERD000MENTSN7~AF-Ol