2004-03-29_REPORT - M1977062

• Permit No: M1977062
• IBM Index Class Name: Report
• Doc Date: 3/29/2004
• Doc Name: Annual Fee/Report/Map
• From: Benson Brothers
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Benson Brothers
M-1977-062
Hallenbeck Pit No 1
April 2, 2004
ass
RE~.e~IED
NAR 2 9 2004
6Aris`wn d Mimrala 8 f~WotY
$688.00 (Due on or before your anniversary date)
Delta
_ According to C_RS._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 ynnr revised written anneal report and annual re op rt maTn to this form. 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: Ed Benson
Permittee Name: Benson Brothers
Address: _. .- ~1~~/D Ausnty R~~+p
~us-rlnl Cr3 Rly1~
Austin, CO 81410
Phone Number:
Fax Number:
[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.
~~~/mil ~-~Z ~ i^ ~_
S ~ lure of Corporate Of icer, Owner, or Designee
~/,~-/off
Dates,