2006-03-08_REPORT - M1987023

• Permit No: M1987023
• IBM Index Class Name: Report
• Doc Date: 3/8/2006
• Doc Name: Annual Fee/Report/Map
• From: Ricky W. Mitchell
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
r/ ANNf1Ai. FF.F. and REPORT RF.nfiF.ST
'~ Ricky W. Mitchell
M-1987-023
Mitchell Pit
March 31, 2006
RECEIVED
"MAR Q E 2006
~ision of Minerala 8 Gaolopy
$281.00 (Due on or before your anniversary date)
Adams
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 beginning
of active operations, and the date active operations ceased for the year, if any.
please atfarh ynnr revised written anmral re~nrt and annnal re,~prt m n this 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:
Permittee Name:
Address:
Ricky W. Mitchell
Ricky W. Mitchell
P.O. Box 10
Bennett, CO 80102
Phone Number: [phone]
Fax Number:
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, orporate Officer, Owner, or Designee
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Date