2005-08-18_REPORT - M1984155

• Permit No: M1984155
• IBM Index Class Name: Report
• Doc Date: 8/18/2005
• Doc Name: Annual Fee/Report/Map
• From: Dolores County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dolores County
~/M-1984-155
Bartley Gravel Pit
September 27, 2005
$688.00 (Due on or before your anniversary date)
Dolores
t/AUG 1 8 2005
Division of fJuEC~a~~ a..: ~..

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
operatorshall- submit`tlse-anrrafifee~ a cels6rt-and map showing the extent of current disturbances Yo aTfecfed - -
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 annnal report and annnal retort main, fn 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: Tim Huskey
Permittee Name: Dolores County
Address: P.O. Box 608
Dove Creek, CO 81324
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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tSignature of Corporate O~ er, Owner, or Designee
~_ 3_~Sr.
Date
M:~PERMI7UTASTERD000MEMSM-AF-04