REP04205

• Permit No: M1977151
• IBM Index Class Name: Report
• Doc Date: 2/2/2004
• Doc Name: Annual Fee/Report Notice
• From: R M Hiner Construction Co. Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

N~ ~ ~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
R M Hiner Construction Co., loc.
M-1977-151
Greeley Pit
January 30, 2004
$688.00 (Due on or before your anniversary date)
Weld
RECE~
FEB 0 2 2004

Division of Minerals & Oe010aY
According to C.R.S. 34-32.5-] 16 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 affacted land,
--t'eelaettatien-aeee:~is'~,~d-t:,-date-and-during-the-gFeceding~eat; new-disturbances-that-ar~antcipatcd-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 re~nrt and anmral rennrt maRM this form. Please rote that an
adequately labeled map that clearly deli»eates and ineh~des the above elements may suffice for a written report.
Division records indicate the following petmittee contact information. Please verify and make anl~ necessary
changes:
Permittee Contact: Rex M. Hiner
Permittee Name: R M Hiner Construction Co., Inc.
Address: I 1 Austin Road
Lamar, CO 81052-4301
Phone Number: (719) 33b-3467
Fax Number: [phone]
719!336-5031
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.
\~~~~7 ~' i ~~ 117L~.11
Signature of Corporate Officer, Owner, or Designee
Janaury 28, 2004
Date
M:IPHRMIT\M AS'rLRDOCUM ENl'S~M-AF-01