2002-01-14_REPORT - M1979216

• Permit No: M1979216
• IBM Index Class Name: Report
• Doc Date: 1/14/2002
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fremont County
M-1979-216
Dist No 2 Gravel Pit
January 20, 2002

RE~~~vE~
1~,~ ~ y 2002
pivi4ton et Minerals and Ge01o9'~
$281.00 (Due on or before your anniversary date)
Fremont
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; reclarnatiob 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 resort map to this form. Please trote that an
adequately labeled map thnt clearly delineates and includes the above elements inay suffice for a writtetr
report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: d4en-IEko
Permittee Name: Fremont County
Address: R-Ar~o~c~38r
~tnpaxi,~S-123
~~~a~t~~-rotes , ~,S~ZC S~y~ .
~n.o4 bl~xQ~~ ~CsT
6ts 'Mtn ~s~
~,~tvo~IG~~ co ~tztz
Phone Number: (~9}~9#2-1177a ~ pj • Z~(~- ~3Z0
Fax Number: (ZL9}~4~ 4-1-78- ~-t°~ - Z75- ~(~Z~
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
~~i~~a I
Date
III IIIIIIIIIIIII III
999
ANNUAL FEE and REPORT REQUEST
M ~PERMRV+IASTERD000MENTSU1-AF-01 ' 1
r.