2010-05-21_REPORT - M1978192

• Permit No: M1978192
• IBM Index Class Name: REPORT
• Doc Date: 5/21/2010
• Doc Name: Annual Fee/Report/Map
• From: Chaffee 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:
,?? *-
1
ANNUAL FEE and REPORT REOUEST
Chaffee County
M-1978-192
Pit No 6
June 30, 2010
IVED
? MAY 21 2010
J Division of Reclamation,
Mining & Safety
$323.00 (Due on or before your anniversary date)
Chaffee
_According to C.R.S. 34-32:5-116-o:-C.R:S.--34 32-1.1-6;-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 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: Joe Nelson Q? _ 4n t= Jvk7 e-f>
Permittee Name:
Address
Phone Number
Fax Number:
Chaffee County
P.O. Box 699
Salida, CO 81201
[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 along with your written report and map. Annual Report instructions are
enclose .
JOE /V t= ?SOnI
Si a e of orporate Officer, Owner, or Designee

Date
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