2006-06-15_REPORT - M1991073

• Permit No: M1991073
• IBM Index Class Name: Report
• Doc Date: 6/15/2006
• Doc Name: Annual Fee/Report/Map
• From: Kiowa County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
// ANNTIAI, FF.F, and RF.Pt7RT RROfiFST
~/ ICiowa County
~M-1991-073
Ferris Pit
RECEa~J~
~ JUN 152006
/ UivisionoiMinernlae~g~togy
July 12, 2006
$281.00 (Due on or before your anniversary date)
Cheyenne
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- ~hall_submit the annual feeFa 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 ~nur revised written annnal re~ rt and anm~al reAnrt mat to this form. Please note [hat 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: Rick Spady
Permittee Name: Kiowa County
Address: P.O. Box 100
Eads, CO 81036
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 aze
enclosed.
S gn-~~f Cdrporate firer, Owner, or Designee
6-/~- ©~
Date
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M:~PERMINIASTERD000MENTSNR-AF-04