2004-12-21_REPORT - M1996049

• Permit No: M1996049
• IBM Index Class Name: Report
• Doc Date: 12/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Everist Materials LLC
• 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:
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Everist Materials, LLC
M-1996-049
Maryland Creek Ranch
December 20, 2004
$688.00 (Due on or before your anniversary date)
Summit
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DES Z ~ ~
Oiviaian of Minerals and yep%BY
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 Iodate 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 annnal rennrt and anm~al re~nnrt man to thin 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: Greg Norwick
Permittee Name: Everist Materials, LLC
Address: P.O. Box 1150
Silverthorne, CO 80498
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signat C rporate Officer, Owner, or Designee
Date