REP09503

• Permit No: M2002094
• IBM Index Class Name: Report
• Doc Date: 12/16/2004
• Doc Name: Partial AF and Rpt-OK
• From: Maverick Sand & Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
~~~.~ ~ t
RPT
W""'~
~~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Maverick Sand & Gravel
M-2002-094
Allen Pit
January 23, 2005
$688.00 (Due on or before your anniversary date)
Montrose
DEC -1 a zt,ua
9ivision of f.;ia~~nls & Geolopq
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_re_port 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 ym~r revised written annual report and anmial re~~nrt main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: ,
Permittee Contact: James E. Stover
Permittee Name: Maverick Sand & Gravel
Address: P.O. Box 99
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.
~~ ~G~ Ij'7~~
St ature of Corporate Officer, Owner, or Designee
~~~>/ ~
Date