2002-01-10_REPORT - M1986004

• Permit No: M1986004
• IBM Index Class Name: Report
• Doc Date: 1/10/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Harold Brandstadt
M-1986-004
Brandstadt Rock Pit
January 24, 2002
RECEIVED
JAN 10 2002
Division of Minerals and Geology
$281.00 {Due on or before your anniversary date)
Delta

According [o 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 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 vour revised written annual report and annual report map to this form. Please mote that an
ndeyuately labeled map that clearly delineates and includes the above elements may since for a n~ritten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Harold Brandsstadt
Permittee Name: Harold Brandstadt
Address: 2040 G Rd.
Phone Number:
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.
Signature of Corporate Officer or Owner
nn ~ 2n n ~_
Da
Delta, CO 81416
[phone]
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