2006-01-19_REPORT - M1992003

• Permit No: M1992003
• IBM Index Class Name: Report
• Doc Date: 1/19/2006
• Doc Name: Annual Fee/Report/Map
• From: Silver Mountain Preserve Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
i/ ANNiTAi. FF,F. and RF,PnRT RF.nifFST
t/ Silver Mountain Preserve, Inc.
M-1992-003
Willis Pit
February 7, 2006
JAN 19 2006
/urv~smu ~,~ ,nmeris and Geology
$281.00 (Due on or before your anniversary date)
Huerfano
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-su~t`the annual ee, a rid map~fie ezteni of current rsturbances 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 Ymir revised written anm~al reTnrt and annual report man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Travis R. Crawford
Permittee Name: Silver Mountain Preserve, Inc.
Address: 11850 CR 520
La Veta, CO 81055
Phone Number: [phone]
Fax Number: [phone]
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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 alon"g with your written report and map. Annual Report instructions are enclosed.
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Signature of Corporate Officer, Owner, or signee ~
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Date