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.;. <br /> <br /> <br />• iii iuiiiiiiiiii iii <br />ANNUAL REPORT ~~, tr) <br />r <br />PERMITTEE NAME: Dolores County F E6 z g 2000 ®~ ~ 11 <br />PERMIT NO.: M-1995-010 neralb&Geo1o9Y~ <br />ptvision of Mt <br />OPERATION NAME: Black Snag <br />ANNNERSARY DATE: March 24, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $225.00 <br />COUNTY: Dolores <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding yeaz, new <br />disturbances that are anticipated to occur during the upcoming yeaz, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the yeaz, if any. <br />Please attach your revised annual report maa and written report to this annual report. <br />Please note that an adequately lnbeled map that clenrly delineates mid includes the above <br />elements may since fora written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Tim Huskey Company: Dolores County <br />O Box 608 <br />Dove Creek <br />PhoneNo.:( 970 ) 677-2328 <br />FAX No.: ( 970 ) 677-3759 <br />If there aze additional comments and/or information that should be provided to the Division, <br />please provide it on a sepazate sheet and attach it to this report form along with your map and/or <br />written report. <br />J >,-19-00 <br />Signature of orate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M: WERMrIV.1ASTERD000MEM'SN1-AF-OI <br />