REP26603

• Permit No: M1989030
• IBM Index Class Name: Report
• Doc Date: 5/3/2004
• Doc Name: 2004 Annual Report
• From: San Miguel County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVEC
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
San Miguel County
M-1989-030
Zadra Pit
May 15, 2004
$688.00 (Due on or before your anniversary date)
San Miguel
MAY 0 32004
Uipision of Minerals end Cpology
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 can-ent disturbances to affected
__- _~_land,_reclamat3on-accomplished-to-date-and-during-the-preceding year; new disturbancesthatare 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 ynnr revised written anmral rennrt and anmral re nr; t man to fhic form- 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Mike Horner
Permittee Name: San Miguel County
Address: P.O. Box 426
Norwood, CO 81423
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.
d~GlYl1.e /Tl-
Signa re of Corpora e Officer, Owner, or Designee
`f ~ 3O
Date
M:IPERMITMASTERDOCUMENTSUI-AF-04