2001-11-13_REPORT - M1991035

• Permit No: M1991035
• IBM Index Class Name: Report
• Doc Date: 11/13/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIII~~IIIIII III
ANNUAL FEE and REPORT REQUEST
RECE~b'E~
NOV 1 3 ~?~t
Division of Minerals aad Gtoln~;
PERMITTEE. NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FETE DUE:
COUNTY:
Western Mobile, [nc.
M-1991-035
Bluestone Pit
November 5, 2001
$688.00 (Due on or before your anniversary date)
Jefferson
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
shall submit the annual fee, a report and map showing [he extent of current disturbances [o 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 attaclt~our revised written annual report and annual report map to this form. Please note that an
adequately labeled mnp that clearly delineates mld i~lcludes the above elements mny since for n x~ritten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Con[acC Em-Rcekerttin€
Permittee Name: Western Mobile, Inc.
Address:
Phone Number:
Fax Number:
1590 W. 12th Ave.
Denver, CO 80204
[phone]
[phone]
- ~~! L S
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach i[ to this form along with your written report and map. Annual Report instructions are enclosed.
-~~r~.E AJ CU~r.
Signature of Corporate Offic o Owner
// ~ 0 /
Dale
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