2006-08-08_REPORT - M2004036 - Laserfiche WebLink

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~~. ~ec~ PERMITTEE NAME: PERMTT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: t/ANNUAL FEE and REPORT REQUEST / /Mason A. King ~ M-2004-036 King Pit August 5, 2006 ~~1~~~~1f~® vAUG 0 82006 Division of Minerals and GeoloBY $281.00 (Due on or before your anniversary date) Washington According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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.dafe_and.during.the-preceding-year, new disturbances that aze-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 map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map (All are required regardless of the level of disturbance or absence of disturbance during the previous year). 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: Mason A. King Permittee Name: Mason A. King Address: 6455 CR XX Phone Number: Fax Number: P.O. Box 68 Cope, CO 80812 (970)357-4245 (970)357-4349 If you have additional comments and/or information that should be below or attach it to this form along with your written report and map. Signa re of Corporate Officer, Owner, or Designee provided to the Division, please provide it Annual Report instructions are enclosed. g`~'~(~ Date