REP36894

• Permit No: M1990047
• IBM Index Class Name: Report
• Doc Date: 1/12/2005
• Doc Name: Annual Report and Fee
• From: Fremont County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMTI' NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fremont County
M-1990-047
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Quargmire Creek
January 20, 2005
$281.00 (Due on or before your anniversary date)
Fremont
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 affect_ed_ _,
-' _-~ -land,-rectamatiori accomplished fo date and during tfie prpreceding 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 attach ynnr revised written anm~al report and anm~al repo m to 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 pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Paul Garrett
Permittee Name: Fremont County
Address:
Phone Number:
Fax Number:
Fremont County Commissioners
615 Macon Ave., Room #105
Canon City, CO 81212
[phone]
[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 of Corporate Officer, Owner, or Designee
1~~~~0~
Date
M:~PERMITMASTERDOCUMEMSUI-AP-04