2001-03-08_REPORT - M1980052

• Permit No: M1980052
• IBM Index Class Name: Report
• Doc Date: 3/8/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

• III IIIIIIIIIIIII III
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ANNUAL FEE and REPORT REQUEST RECEIVED
PERMITTEE NAME: F and K Holsinger MAR 0 & 2001
PERMIT NO.: M-1980-052
Division of dais and Geology
OPERATION NAME: Holsinger Gravel Pit
ANNIVERSARY DATE: April23,2001
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Jackson
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 your revised written annual report and annual report map to this form. Please mote 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: Keith Holsinger n e
Penn ittee Name: F and K Holsinger /tit ..-c.a O'�,4
Address: P.O. Box 37
Walden, CO 80480
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 are
enclosed.
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Sig Lure of orporate Offi er Owner
Date
M.\PERMITVMASTERD000MENTSW-AF-01 - -- -