REP10819

• Permit No: M1981286
• IBM Index Class Name: Report
• Doc Date: 2/25/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

1:
V
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Weld County
M-1981-286
Thomas Gravel Pit 4
RECEIVED
FEB 15 20D3
March 1, 2003
$688.00 (Due on or before your anniversary daiD~~sian of Minerals and Geology
Weld
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-176,-each-year, on the anniv_ersary_date of_the permit,_an_ __ _-
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and dwing the preceding year, new disturbances that are anticipated to
occw 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 report m =n to his 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: Greg Nelson ~~
Permittee Name: Weld County
Address: P.O. Box 758
Greeley, CO 80632
Phone Number: [phone] x _~i 7SC~
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.
tgnature o orporate Officer, Owner, or Designee
a/~>~Q
Date
M:\PERMINNASTERDOCUM ENTSVN-AF-04