2009-07-27_REPORT - M2004037

• Permit No: M2004037
• IBM Index Class Name: REPORT
• Doc Date: 7/27/2009
• Doc Name: Annual Fee/Report/Map
• From: John M. Everitt
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: ECS
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
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ANN FEE-and ?RT RE VEST
e/? John M. Everitt
j4W-2004-037
Everitt Pit
August 3, 2009
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7 7 CF-IV '.
L 2 7 2009
Division ui rm;:uGrriatiut:,
Mining and Safety
$$323.00 (Due on or before your anniversary date)
Phillips
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
durm t1?e-a13coming year,-reclamation-that will- be per-formed-during the coming ear, the daws? fkr the begin ing
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 during the previous year and no new changes to
the previous year's map are necessary, then no new map 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: John M. Everitt
Permittee Name: John M. Everitt
Address: 24274 CR 17
Phone Number:
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.
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Sign e of Corporate Officer, Owner, or Designee
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Date
Haxtun, CO 80731
[phone]