2003-10-01_REPORT - M1991086

• Permit No: M1991086
• IBM Index Class Name: Report
• Doc Date: 10/1/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Bent County
M-1991-086
Earl-Hoffman-Reyher
October 3, 2003
ocr - ~. Zoos
Division if Minerals and Geology
$688.00 (Due on or before your anniversary date)
Bent
- -- According to-C:R:S:~4=32.5-11fi'orC.-R.S:'34=32=1"Ib, each year, on [ tl-e 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 attach your revised written anneal rennrt and anneal rennrt 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gary Pritchard
Permittee Name: Bent County
Address: P.O. Box 350
Las Animas, CO 81054-0350
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.
Stgnatur of Corporate Officer, Owner, or Designee
09- D8-~o~03
Date
M:IPERMITVNASTERDOCl1MENTSUI-AF-04