2005-03-03_REPORT - M2000059

• Permit No: M2000059
• IBM Index Class Name: Report
• Doc Date: 3/3/2005
• Doc Name: Annual Fee/Report/Map
• From: Geroux Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Geroux Gravel
M-2000-059
Geroux Gravel
February 22, 2005
i ~„ 0 :, 2CG5
.'i~rision of i.~i„ r. L, 0 Gaalopy
$281.00 (Due on or before your anniversary date)
Custer
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,
-" -restat~satiarr'a~omptished-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 ynnr revised written anm~al report and annual r ort mAn 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: Darrell Geroux
Permittee Name: Geroux Gravel
Address: 1100 CR 160
Westcliffe, CO 81252
Phone Number: [phone]
Fax Number: [phone]
.____ If you have additional comments and/or information that should be provided fo 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
or Designee
Date