GENERAL47724

• Permit No: M1984094
• IBM Index Class Name: General Documents
• Doc Date: 10/4/2006
• Doc Name: Oerator Requests via Fax & US Mail
• From: DRMS
• To: Sanborn Sand and Gravel
• Media Type: D
• Archive: No

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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
RECEIVED
JUN 0 62006
Division of Minerals enJ GeeleAY
According~to•G':R:S: 342-5=FP6-orC:R:S-34=32=t-1Cr; each'year; on'the anniversary date'offhe permit; ari 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 ynnr revised wijften annnal tenor[ and annrial tenor[ maR to this form. The Annual R¢port
& Fee requirement is not met until we have received the following 3 components: ~ rennrt and acsneiated
map (A113 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
su~ee jot a uritten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Micheal P6stev
Permittee Name: Sanbom Sand and Gravel
Address: P.O. Box 1180
Alma, CO 80420
Phone Number: [phone]
Fax Number: (7l9) 836-0849
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