2008-09-05_REPORT - M1979163

• Permit No: M1979163
• IBM Index Class Name: REPORT
• Doc Date: 9/5/2008
• Doc Name: Annual Fee/Report/Map
• From: Las Animas County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
1r l
ANN&L FEE and LPORT REQUEST
Las Animas County
1VI-1979-163
Shannon Pit
September 27, 2008
RECE ED
,x,'d0 5 2008
Division of Reclamation,
Mining and Safety
$$323.00 (Due on or before your anniversary date)
Las Animas
___-According to C.R.S. 34-32.5-116_ 9r -C--&-$- 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, 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 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 durin2If no new disturbances or reclamation have occurred the Previous year and no and no
new changes to theprevious year's map necessary, then no new map reguiredprovided that the
the previous year's mapare necessary, then no new mapis reguiredprovided that the
Operator shall state this in the Annual Report. 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: Phil Dorenkamp
Permittee Name: Las Animas County
Address: 2000 N. Linden Ave.
Trinidad, CO 81082
Phone Number:
Fax Number:
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
bjgw or attach it to this form along with your written report and map. Annual Report instructions are
?ature of C6rporate Officer, O r, or Designee
a- a dg
Date
M: PERMITUVIASTERDOCUMENTS\M-AF-04