2011-09-13_REPORT - M1977075

• Permit No: M1977075
• IBM Index Class Name: REPORT
• Doc Date: 9/13/2011
• From: Holyoke Gun Club
• 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:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
S
Date
Ross Brinkema
c1 /A.
Holyoke Gun Club
58700 Rd. FF
Holyoke, CO 80734
(970) 854 -5315
(970) 854 -3114
Corporate Officer, Owner, or Designee
it
ANNUAL FEE and REPORT REQUEST
olyoke Gun Club
I -1977 -075
Holyoke Gun Club Pit
September 27, 2011
$$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. ate_ anticipated_to_occuut.— - ---
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:
, - 30'1 Zc/ C 2c)
SFP 1 3 2011
Division of Reclamop,
Mining and Safety
If you have additional comments and/or information that should be provided to the Division, please provide it
below o attach it to this form along with your written report and map. Annual Report instructions are enclosed.