REP49251

• Permit No: M1987020
• IBM Index Class Name: Report
• Doc Date: 4/21/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Rio Grande County
M-1987-020
374 Pit
RECElVEC
APR 2 1 2003
Apri123, 2003 Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Rio Grande
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
----operato~shall_submit_the anmral_fee,_a_r~poR-and_map_showing_the-extentmf_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 ym~r revised written annnal report and annnal re; nrt maTtp 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 petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lawrence "Buddy" Shaver
Permittee Name:
Address:
Phone Number:
Fax Number:
Rio Grande County
168 N. Washington
P.O. Box 46
Monte Vista, CO 81144
[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
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Date
M:\PERM ITMASTERDOCUMENTSU1-AF-04