REP01013

• Permit No: M1983109
• IBM Index Class Name: Report
• Doc Date: 8/1/2002
• Doc Name: 2002 Annual Report
• From: Kiowa County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Kiowa County
M-1983-109
Aldrich Gravel Pit
August 25, 2002
RECEl1/~D
AUG 0 12002
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Kiowa
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 [o 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 resort and annual report map 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: Rick Spady
Permittee Name: Kiowa County
Address: P.O. Box 100
Phone Number:
Eads, CO 81036
[phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide i[
below or attach it to this form along with your written report and map. Annual Repor[ instructions are
enclosed.
Signature of Co bratp a Off or Owner
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