REP15301

• Permit No: M2002053
• IBM Index Class Name: Report
• Doc Date: 1/29/2007
• Doc Name: Inadequate Ltr
• From: DRMS
• To: John R. Kurtzer
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMTITEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
John R. Kurizer
M-2002-053
Kurtzer Pit
November 27, 2006
$$281.00 (Due on or before your anniversary date)
Phillips
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 aze 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 yeaz, if any.
Please attach your revised written annual renort and annual report man to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, renort, and
associated maa. If no new disturbances or reclamation have occurred durinc the nrevious vear and no
new chances to the previous year's man are necessary, then no new maa is reuuired, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may since for a written report,
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: John R. Kurtzer
Permittee Name: John R. Kurtzer
Address: 24463 CR 1l
Haxtun, CO 80731
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.
Signature of Corporate Officer or Owner
Date