2001-05-21_REPORT - M1985031

• Permit No: M1985031
• IBM Index Class Name: Report
• Doc Date: 5/21/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REpUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Montezuma Couuty
M-1985-031
Mancos Gravel Pit
May 31, 2001

RECEI~/ED
MAY 2 1 2001
Division of Minerals and Geology
$550.00 (Due on or before your anniversary date)
Montezuma
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 dismrbances 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 vour revised written annual resort and annual resort map to this form. P/ease note that an
adequately labeled map that clearly delineates and includes the above elements ntay since jor a written
report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lloyd Everett
Pennittee Name: Montezuma County
Address: 1680 Hwy. 145
Cortez, CO 81321
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 i[ to this form along with your written report and map. Annual Report instructions are
enclosed.
Ignaturd of Corporate Officer or Owner
5~/y ~o ~
Date
M NERMITMASTERDOCUMENTSNI-AF-0-0