2007-04-17_REPORT - M1994007

• Permit No: M1994007
• IBM Index Class Name: Report
• Doc Date: 4/17/2007
• Doc Name: Annual Fee/Report/Map
• From: Phillips County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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AL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
'/Phillips County
~VI-1994-007
Johnson Pit
May 23, 2007
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$$688.00 (Due on or before your anniversary date)
Phillips
According to C.R.S_34-32.5-116_ or_C.R_.S. 34-32-1_16, 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
beginning of active operations, and the date active operations ceased for the yeaz, if any.
Please attach vour revised written annual report and annual resort map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred durinti the previous year and no
new chanties to the previous year's map are necessary. then no new mau is required, provided that the
Operator shall state this in the Annual Report. 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 pennittee 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
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature f Corporate fficer, Owner, or Designee
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Date
M:~PERMI'IUTASTERDOCUMENTSU.I-AF-04