2001-07-12_REPORT - M1984040

• Permit No: M1984040
• IBM Index Class Name: Report
• Doc Date: 7/12/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST L� n
PERMITI'EE NAME: Larry L. Chartier
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PERMIT NO.: M-1984-040
OPERATION NAME: Chartier Pit do
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ANNIVERSARY DATE: July 19,2001 �C°O�OeY
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Morgan
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`yeai-, 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 report 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: Larry L. Chartier
Permittee Name: Larry L. Chartier
Address: 21305 Road 28.5
Brush,CO 80723
Phone Number: [phone]
Fax Number:
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.
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Signature of 06rporate Officer or Owner
Q'TI I " o
Date
MAPERMITWASTERDOCUMENTSW-AF 01