2001-01-12_REPORT - M1986004

• Permit No: M1986004
• IBM Index Class Name: Report
• Doc Date: 1/12/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

999
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: Harold Brandstadt RECEIVED
PERMIT NO.: M-1986-004 JAN 11 1001
OPERATION NAME: Brandstadt Rock Pit Division of Miner,:ls and Geology
ANNIVERSARY DATE: January 24, 2001
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Delta
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 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 your revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements mcry suffice for a writen
report.
Division records indicate the following pennittee contact information. Please verify and make any necessary
changes:
Pe mittee Contact: Harold Brandsstadt
Permittee Name: Harold Brandstadt
Address: 2040 G Rd.
Delta, CO 81416
Phone Number: [phone]
Fax Number:
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 or Owner
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M?PERM IT)MASTERDOCU M ENTSVd-AF-01