2001-11-14_REPORT - M1992113

• Permit No: M1992113
• IBM Index Class Name: Report
• Doc Date: 11/14/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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Bent County
M-1992-113
Verhoeff Pit No 2
December 17, 2001
NOV 14 200}
DiYiaion of Minerals and GeologF
$688.00 (Due on or before your anniversary date)
Bent
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
lands reclamation accomplished to date and during the preceding year, new disturbances [hat 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 your revised written annual report and annual report maa to this form. Please note that an
adequately labeled map that clearly delineates and includes the ahove elements Wray suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Perrnittee Contact: Gary Pritchard
Permittee Name:
Address:
Ben[ County
P.O. Box 350
Las Animas, CO 81054-0350
Phone Number: [phone]
Fax Number: [phone]
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 Repott instructions are
enclosed.
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Signatur of Corporate Officer or Owner
Date
A1:~PERMI N.IASTERD000MENTSNA-AF-61