2005-09-14_REPORT - M2001068

• Permit No: M2001068
• IBM Index Class Name: Report
• Doc Date: 9/14/2005
• Doc Name: Annual Fee/Report/Map
• From: Tamrock Gravel
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Tamrock Gravel
;,~I-2001-068
Bottomless Pit
6~ ~
RE~EI~E~
~EP 1 4 2005
September 17, 2005
~Givision of Minerals and Gcology
$688.00 (Due on or before your anniversary date)
Las Animas
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 mnr reviced written anneal rennrt and anneal rennrt 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: Brent Tamburelli
Permittee Name:
Address:
Tamrock Gravel
137 Plum
Trinidad, CO 81082
~Phone`Numbei•: -[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.
~~ ~~.~-%
Signature of Corporate Officer, Owner, or Designee
-!~~

Date