2010-10-18_REPORT - M1981220

• Permit No: M1981220
• IBM Index Class Name: Report
• Doc Date: 10/18/2010
• Doc Name: Annual Fee/Report Notice
• From: San Miguel County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REOUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
San Miguel County
M-1981-220
Klondike Pit
November 20, 2010
$791.00 (Due on or before your anniversary date)
San Miguel
v'Sii®
MIT 18 2010
f ivon ua tI a:'. iation,
S. ping ar,d S'a ty
_ _ _ According-to-C.R.S_. 34-32.5-116_or__C.R.S._3.4-32-116, eachy_ear,_on the_anniversary_date_of?he 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 vour revised written annual report and annual report man to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated may. If no new disturbances or reclamation have occurred during the previous year and no
new changes to the previous vear's map are necessarv. then no new man 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 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.
Signature of C4orate Officer, Owner, or Designee
Date
M:\PERMIT1MASTERDOCUMENTS\M-AF-04