2011-04-14_REPORT - M1987020

• Permit No: M1987020
• IBM Index Class Name: REPORT
• Doc Date: 4/14/2011
• Doc Name: Annual Fee/Report/Map
• From: Rio Grande County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

A?-- *- QR-r
ANNUAL FEE and REPORT REOUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
I
Rio Grande County
M-1987-020
374 Pit
April 23, 2011
RECEIVED
? APR 142011
Division of Reclamation,
Mining & Safety
$791.00 (Due on or before your anniversary date)
Rio Grande
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 s-liall-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 may, If no new disturbances or reclamation have occurred during the previous year and no
new changes to the previous year'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 suff ce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Patrick Sullivan
Permittee Name: Rio Grande County
Address: P.O. Box 46
168 N. Washington
Monte Vista, CO 81144
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 a ch it to this form along with your written report and map. Annual Report instructions are
enc? sect
Signature of Corporate Officer, Owner, or Designee
Date
M:SPERM'IIMASTERDOCUMENTS\A4-AF-04