2010-05-17_REPORT - M1989030

• Permit No: M1989030
• IBM Index Class Name: REPORT
• Doc Date: 5/17/2010
• Doc Name: Annual Fee/Report/Map
• From: San Miguel County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REOUEST
lySan Miguel County
M-1989-030
Zadra Pit
May 15, 2010

VI/ MAY VT Zo
-et, Division of Reclamation,
Mining & Safft,
$791.00 (Due on or before your anniversary date)
San Miguel
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 af-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 followin=g 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: Mike Horner
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided t:o the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
411D
Date
M:IPERMIT1MASTERDOCUMENTS\NI-AF-04