REP08867

• Permit No: M1986061
• IBM Index Class Name: Report
• Doc Date: 8/2/2001
• Doc Name: ANNUAL REE AND REPORT REQUEST
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
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PERMITTEE NAME:
PERMff NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Patrick L. Cugnini
M-1986-061
Cugnini Gravel Pit
July 21, 2001
$688.00 (Due on or before your anniversary date)
La Plata
Division of Minerals and G~c c
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 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 resort map to this form. Please note char arc
adequately labeled map that clearly delineates and includes the above e[ernerus may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contac[: Don L. Gosney
Permittee Name: Patrick L. Cugnini
Address: P.O. Box 367
Bayfiled, CO 8] l22
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 instmctions are
enclosed.
Signature of Corporate Officer o caner
7130101
Date
At: WERMrM1ASTERD000M ENTSNI-AF-01