REP13902

• Permit No: M1990131
• IBM Index Class Name: Report
• Doc Date: 2/12/2002
• Doc Name: 2002 Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~f
~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Wayne A & Jerry A Mitchell
M-1990-131
Mitchell Pit No 2
February 14,2002
RECE~~El~
FEE t ?1001
Oluisian of Minerals and GeoloBY
$281.00 (Due on or before your anniversary date)
Adams
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on the anniversary date of [he permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accotnplished to date and during the preceding year, new disturbances [hat are anticipated to occur R
during [he 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. 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: Wayne Mitchell
Permittee Name: Wayne A & Jerry A Mitchell
Address: P.O. Box 267
Bennett, CO 80102
Phone Number: [phone]
-----Fax-I'~umber. ~'-
If you have additional comments and/or information [hat 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 instmctions are enclosed.
Signatu of Corp/orate Officer or Owner
o`L/ d /o z
Dat~
M:~PERMITM ASTERDOCU MCNTSVvI-AF-OI