REP03781

• Permit No: M1978210
• IBM Index Class Name: Report
• Doc Date: 2/22/2002
• Doc Name: 2002 Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Weld County
M-1978-210
Geisert Pit
March 1, 2002
$688.00 (Due on or before your anniversary date)
Weld
A'E~EIVFD
DEB~2~
Ji aision of ~irtera(s and CB
dlC~r
According [o 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
]and, reclamation accomplished to date and during the preceding year, new disturbance`s [hat 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 vour revised written annual report and annual report map to this form. Please note than 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: Greg Nelson
Permittee Name: Weld County
Address: P.O. Box 758
Greeley, CO 80632
Phone Number: [phone]
Fax Number: (970} 304-6497
X-3 75U
If you have additional comments and/or information that should be provided [o the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
ignature ~ f Corporate Officer or Owner
o? //02 /d J
Date
M aPERM^1A9ASTERDOCLM1IENTSVd-AF-03