REP00375

• Permit No: M1985031
• IBM Index Class Name: Report
• Doc Date: 5/21/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

I-

RECEIVED
MAY 2 1 «~3
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Montezuma County
M-1985-031
Mancos Gravel Pit
May 31, 2003
$688.00 (Due on or before your anniversary date)
Montezuma

Siuisian ~t Minerals and Gaolo~y
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 thaCare anticipated'to
occur during the upcomi ~¢ vear, reclamation that will be performed during the coming year, the dates for the i
beginning of active oper ~ the date active operations ceased for the year, if any.
Please attach y~r revised written annnal rennrt and annnal rennrt main to 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lloyd Everett
Permittee Name: Montezuma County
Address: 1680 Hwy. 145
Cortez, CO 81321
-_ _ Phone Nu~tbec__ (9~ 565-8666
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.
gna[ure Corporate Officer, Owner, or Designee
Sl ~~6~
Date
M:IPERMITMASTERDOCUMENTSUI-AF-04 C ~~ /, ~. /J
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