2005-06-10_REPORT - M1995012

• Permit No: M1995012
• IBM Index Class Name: Report
• Doc Date: 6/10/2005
• Doc Name: Annual Fee/Report Notice
• From: cecil c powell
• To: dmg
• Media Type: D
• Archive: No

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ANNTiAT. FF.F, and RF,PT)RT RF.OTIF.ST RECEIVED
PERMITTEE NAME: Cecil C Powell SUN ~ ~ Z~QS
PERMIT NO.: M-1995-012 ~ ~ S gfclsion at Minerals and Ganlogy
OPERATION NAME: Powell's Gravel Pit
ANNIVERSARY DATE: May 12, 2005
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Moffat
sha]l 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 anmial re,~nrt and annnal reQnrt maT to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a xmltten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ceci] C. Powell
Permittee Name: Cecil C Powell
Address: P.O. Box 23
Dinosaur, CO 81610
Phone Number: [phone]
Fax Number:
Nn mi ni nr~ nr rh.an~ac dye
been made at this site.
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.
~.e~~ ~~~
Signature of Corporate Officer, Owner, or Designee
Date