REP03838

• Permit No: M2000028
• IBM Index Class Name: Report
• Doc Date: 7/9/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME;
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Mike A Ferrero
M-2000-028
Ferrero Pit
Apri126, 2003
RECEIVED
JUL 2 9 2003
Dirisien ~f Minerals and Geolo9Y
$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 submit t_he annual fee, a report and mawshowing the extent of current disturbances to affected land, _ _ ._
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occw
dwing 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.
Pleas alto h ynnr revised written anneal re~nrt and -anneal reRDrt m P to this fnrm_ 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: Mike A. Ferrero
Permittee Name: Mike A Ferrero
Address: 3~.,,3-Hwy. 12 3¢32.
Trinidad, CO 81082
Phone Number: [phone]
Fax Number: FJ~9}9dCs75~~-
!7 /~-~s4 b-`3-t-lb
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.
- ~ GZlC!_Z~~,'i~
ignature of Corporate Officer, Owner, or Designee
Da~~~
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