2009-05-26_REPORT - M2000053

• Permit No: M2000053
• IBM Index Class Name: REPORT
• Doc Date: 5/26/2009
• Doc Name: Annual Fee/Report/Map
• From: Las Animas County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: JLE
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPOR? UEST
`Las Animas County
1/M-2000-053
Castillo Pit
June 12, 2009

CEIVE0
kIMAY Z 62009
Di*ion of Fteclwmgtiva,
Hoing and Safety
$$791.00 (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
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 daring the previous year and no
new chances to the previous vear's may are necessary, then no new may 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: 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
below or attach it to this form Tong with your written report and map. Annual Report instructions are
Si na re of Corporate Officer, 94ner, or Designee
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