2003-10-09_REPORT - M1989095

• Permit No: M1989095
• IBM Index Class Name: Report
• Doc Date: 10/9/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~~~~~~®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Phillips County
M-1989-095
Schneller Clay Pit
November 27, 2003
OCT 0 9 2003
Division of Pdinarals and Gealonp
$281.00 (Due on or before your anniversary date)
Phillips
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
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 ynnr revised written anneal re~nrt and annual rennrt m =n to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a writtett
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Perinittee Contact: Randy Schafer
Permittee Name: Phillips County
Address: 221 S.Interocean
Holyoke, CO 80734
- - -Phone-Numbcr--:-(970) 854=37-78-- - - - - __
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.
~ ~~~
Signature o Corporal-~ficer, Owner, or Designee
/4~~ ~0 3
Date
M iPERM ITVN ASTERDOCUM ENTSVd-AF-04