REP07417

• Permit No: M1980085
• IBM Index Class Name: Report
• Doc Date: 2/19/2004
• Doc Name: Annual Fee/Report Notice
• From: Elam Construction Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

N-pK

RECEIVED
PERMfCfEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Elam Coustruction, Inc.
M-1980-085
Vagneur Site
February 17,2004
$688.00 (Due on or before your anniversary date)
Pitkin
FEB 1.9 2004
Division of Minerals $ GeolopY
According to 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 subm+t the annual FPP a_report-and-map-showing-the extent-of-current-disturbances-to.affected-Ian~C
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 v^nnr revised written annual retort and annnal re~nrt main 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: Harold F. Elam
Permittee Name: Elam Construction, Inc.
Address: 1225 S. 7th St.
Grand Junction, CO 81501
Phone Number: [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 aze enclosed.
ignature of Corporate Offtcer, Owner, or Designee
Harold F. Elam, President
/~~ ~ti 6. ~ v~y
Date
M:~PERMI7~MASTERDOCUMENTSIM-AF-01