REP09377

• Permit No: M1983159
• IBM Index Class Name: Report
• Doc Date: 3/1/2004
• Doc Name: Annual Fee/Report Notice
• From: Tom and Regina Farmer
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME ANNi1At. FRF, and RF.PnRT RF.n
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: Tom and
egina Farmer
PERMIT NO.: M-1983-159 FEB 21 Y0~
OPERATION NAME: Gleason Pit Division of Mi

ANNIVERSARY DATE:
January 30, 2004 ~eials antl Cealug~
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Montrose
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 [he annual fee, a report and map showing the extent of current disturbances to affected land,
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 ynnr revised written annual rennrt and annual rennrt maTtn 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: Regina Farmer
Permittee Name: Tom and Regina Farmer
Address: P. O. Box 39
Redvale, CO 81431
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.
Signature~of Corporate Officer, Owner, or Designee
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Date
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