2006-06-29_REPORT - M1978162

• Permit No: M1978162
• IBM Index Class Name: Report
• Doc Date: 6/29/2006
• Doc Name: Annual Fee/Report/Map
• From: Morgan County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~ j
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNTIAI, FF.F, and RFPORT RFOTiFST
~ /Morgan County
`/ M-1978-162
Harvey Greeu Pit
June 29, 2006
RECEIi/E~
,/j `JUN 2 9 2006
" f?ivisioa of Mioerats aed Geolapy
$688.00 (Due on or before your anniversary date)
Morgan
According to C.R.S.. 34 32.5-116 or C.R.S. 34-32-116, each year, on the anniversary dzte 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 repprt and anm~al renn m~ 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: Joe B. Baltazar
Permittee Name: Morgan County
Address: 17303 CR S
Ft Morgan, CO 80701
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.
Si tature of Corporate Officer, O er, or Designee
Date

M:SPERM711MASTERDOCUMENTS4~r-AF-04