REP35974

• Permit No: M1985165
• IBM Index Class Name: Report
• Doc Date: 11/18/2004
• Doc Name: Annual Report and Fee
• From: Harold A Winter
• 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:
Harold A Winter
M-1985-165
Winter Ranch Pit
November 26, 2004
NOU i ~ 2004
!`ici,ion of Nina,. r e':rt;,;r
$281.00 (Due on or before your anniversary date)
Las Animas
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
-_ shalhsubmit 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 disturlia'nces"tfiat 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 attach your revised written annual rennrt and anneal report main 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: Harold A. Winter
Perenittee Name: Harold A Winter
Address: 20157 CR 75.0
Phone Number:
- ;-=~'az Number:-
Trinidad, CO 81082
[phone]
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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 Corporate Officer, Owner, or Designee
Date