2003-01-23_REPORT - M1989023

• Permit No: M1989023
• IBM Index Class Name: Report
• Doc Date: 1/23/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

V
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Clyde and Marie Couch
M-1989-023
Caliche School Pit
March 9, 2003
~ECEl~ED
JAN 2 3 2003
pivision of Minerals and Geofo9Y
$281.00 (Due on or before your anniversary date)
Logan
According to C.R.S. 34-32.5-116 or C.R.S._34-32-116, each year, on the anniversary dale of the permit, an o ep rator
`shall summit tTie annua ee, a report and map showing the extent of current dtsturbances 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 veer revised written anneal rennrt and anneal rennrt m~ to this form- Please note that 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: Clyde Couch })l2/e W,S UPr4 f~~G ~ldarc~t,
Permittee Name: Clyde and Marie Couch ~ ld 400 -FonS ~ " ~"~~~v~ta•~
Address: 122 State St.
Sterling, CO 80751
-.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.
[gna re of Corporate Officer, Owner, or Designee
-L_"
Date
M:IPERMITMASTERDOCUMENTSVv1-AF-01