2004-04-13_REPORT - M1994007

• Permit No: M1994007
• IBM Index Class Name: Report
• Doc Date: 4/13/2004
• Doc Name: Annual Fee/Report/Map
• From: Phillips County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Phillips County
M-1994-007
Johnson Pit
May 23, 2004
ti
RE~~.:~." b.
APR 1 3 2004
Division of Minerals & GeoloOY
$688.00 (Due on or before your anniversary date)
Phillips
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
o)?erator shall~uhmit the=annualfee,_a reportand m__?rn showing-the_extent-nf_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 yeaz, 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 re_pnrt and annnal re nn rf my~p to this form. Please note That an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Randy Schafer
Permittee Name: Phillips County
Address: 221 S. Interocean
Holyoke, CO 80734
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
be]ow or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signatur f Corpor to Officer, Owner, or Designee
~/~/~ ~
Date
M:~PERMITN-fASTERD000MENTS~hr-AF-09