2001-02-23_REPORT - M1995010

• Permit No: M1995010
• IBM Index Class Name: Report
• Doc Date: 2/23/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III Illllllllllll 111 )(4
ANNUAL FEE and REPORT REQUEST
RECEIVED
PERMITTEE NAME: Dolores County FEB 2 3 tam
PERMIT NO.: M-1995-010 Division of Minerals and Geology
OPERATION NAME: Black Snag
ANNIVERSARY DATE: March 24,2001
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Dolores
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
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
u::-;beginning of active operations, and the date active operatioas;ceased:for th6e ear "jf'anya-
-Please attach your revised written annual report and annual report rnap'to'this4brm. Please nose 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: Tim Huskey
Permittee Name: Dolores County
Address: P.O. Box 608
Dove Creek, CO 81324
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 Report instructions are
enclosed.
Signature of Corporate Off or Owner
. - - h;- 0t
Date . .
M.IPERh4T14A5TERDOCUI,ENTSVd.AF-W