2004-07-21_REPORT - M1983209

• Permit No: M1983209
• IBM Index Class Name: Report
• Doc Date: 7/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Western Slope Construction Co
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME: Western Slope Construction Co
PERMIT NO.: M-1983-209
OPERATION NAME: Benton Dawson Gravel
ANNIVERSARY DATE: July 25, 2004
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Delta
~~C6~~VED
JUL 21 2004
Givisien of Minerals & Ge010gY
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator
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 your revised written annual rennrt and annual re,Fnrf maw 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 fallowing permittee contact information. Please verify and make any necessary
changes;
Permittee Contact: Jack L. Hawkins
Permittee Name: Western Slope Construction Co
Address: 1221 Hwy 50
Delta, CO 8 14 16-3 1 12
Phone Number: [phone]
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.
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Si ture of C rporate Officer, Owner, or Designee
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