REP09250

• Permit No: M1978327
• IBM Index Class Name: Report
• Doc Date: 5/2/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Jake Kauffman & Sons, Inc.
M-1978-327
Kauffman Pit
May 14, 2003
$688.00 (Due on or before your anniversary date)
Larimer
MAY 0 2 2003
Division of Minerals and 6eolagy
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on.the anniversary date of the permits an operator
shaft^sutiinit-the-anneal-fee-a-report-and`maPshowing-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 ymn• revised written anm~al renort and annual red ort m,~ to this form. Please note that an
adequately Labe/ed 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: Mary Kauffman
Permittee Name: Jake Kauffman & Sony Inc.
/ ,
Address: 808 SCR 9E
Loveland, CO 80537
Phone Number: [phone]
Fax Number: [phone]
~ff~~~~~/97.9N ~ SpN LNG
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.
M:~PERMITMASTERD000M ENTSVv1-AF-01
'y-~~ 03
Date