2005-07-19_REPORT - M1983116

• Permit No: M1983116
• IBM Index Class Name: Report
• Doc Date: 7/19/2005
• Doc Name: Annual Fee/Report/Map
• From: kiowa county
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Kiowa County
M-1983-116
Gentz Gravel Pit
August 25, 2005
JUL 19 2005
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$281.00 (Due on or before your anniversary date)
Prowers
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 tttat are anticipated to
occur during the upcoming yeaz, reclamation that will be perfotmed 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 ynnr revised written anm~al report and annnal rennrt m~ to this form. 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:
Permittee Name:
Address:
Phone Number:
Fax Number:
Rodney Hopkins
Kiowa County
P.O. Box 100
Eads, CO 81036
[phone]
[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 Corpor e O tcer, caner, or Designee
7- /~f-~~
Date
M: W ERMITNIAS'rERDOCUMENTS~hf-AF-04