2010-08-05_REPORT - M2004047

• Permit No: M2004047
• IBM Index Class Name: REPORT
• Doc Date: 8/5/2010
• Doc Name: Annual Fee/Report/Map
• From: Farfrumwurkin, LLLP
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: MAC
• Media Type: D
• Archive: No

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PERMITTEE NAME
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
f,
ANNUAL FLE and PORT REQUEST
?Farfrumwurkin, LLLP
''M-2004-047
File Pit 112
August 4, 2010
$$791.00 (Due on or before your anniversary date)
Weld
"CVVW
05 2010
/AUG
Dimon Gt ROC6-w Aoon,
_ Mnin and Safety
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 year, new disturbances that are anticipated to occur
-during-the-upcoming year, reclamation-that- wi11. be- performed -dur_ing-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 annual report and annual report man to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. 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: Jon File
Permittee Name: Farfrumwurkin, LLLP
Address: P.O. Box 983
Broomfield, CO 80038
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.
Sig ature 76, orporate Officer, Owner, or Designee
/0
Date