2005-06-13_REPORT - M1996008

• Permit No: M1996008
• IBM Index Class Name: Report
• Doc Date: 6/13/2005
• Doc Name: Annual Fee/Report Notice
• From: western gravel inc
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Western Gravel, Inc.
M-1496-008 C~ yr -NJ
North R-34 Pit -.d
Apri14, 2005
JUN 1 3 2005
pivisian of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Montrose
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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 upcaming 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 ymtr revised written anmral report and annual report m T to this form. Please note that an
adequately Tabeled map that edearly 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:
Pennittee Name:
Judy DeVincentis
Western Gravel, Inc.
Address: 3001 N. Townsend Ave.
Montrose, CO 81401
Phone Number: [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.
d~Ja-t,~`~ ~!
Si ature Corporate Officer, Owner, or Designee
Date