2003-10-14_REPORT - M1992060

• Permit No: M1992060
• IBM Index Class Name: Report
• Doc Date: 10/14/2003
• Doc Name: Annual Fee/Report/Map
• 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:
City of Moute Vista
M-1992-060
Lagoon Pit
October 20, 2003
$281.00 (Due on or before your anniversary date)
Rio Grande
OC? 1 4 2003
Division of Minerals and Geologg
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 yeaz, new disturbances that aze 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 ylyrr revised written anneal report and anneal re~nrt main 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Bead-finer
Permittee Name: City of Monte Vista
Address: 4 Chico Camino
Monte Vista, CO 81144
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.
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Signature of Corporate Officer, Owner, or Designee
`1/s/o_3
Date
M?PERMITV.rASTERD000MENTSUI-AF-04