GENERAL34372

• Permit No: M1984094
• IBM Index Class Name: General Documents
• Doc Date: 10/2/2006
• Doc Name: Fax request for annual fee to operator
• From: DRMS msr
• To: Sanborn Sand and Gravel
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Sanborn Sand and Gravel
M-1984-094
Gloria Z Mine
July 17, 2006
$688.00 (Due on or before your anniversary date)
Park
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 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 annual report and annual report man to this form. The Annual Report
& Fee requirement is not met until we have received the following 3 components: fee, report, and associated
map (All 3 are required regardless of the level of disturbance or absence of disturbance during the previous
year). Please note that an adequately labeled map that clearly delineates and includes the above elements may
since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Micheal Pfistev
Permittee Name: Sanborn Sand and Gravel
Address: P.O. Box 1180
Phone Number:
Alma, CO 80420
[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.
Signature of Corporate Officer, Owner, or Designee
Date