2003-08-25_REPORT - M1984155

• Permit No: M1984155
• IBM Index Class Name: Report
• Doc Date: 8/25/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dolores County
M-1984-155
Bartley Gravel Pit
September 27, 2003
AUG 2 5 2003
Division a/Minerals and Geology
$688.00 (Due on or before your anniversary date)
Dolores
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
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 ynnr revised written annnal re~nrt and annnal rennrt m ~n to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Tim Huskey
Perinittee Name: Dolores County
Address: P.O. Box 608
Phone Number:
Fax Niunber:
Dove Creek, CO 81324
[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.
ig afore of Corporate Offic caner, or Designee
Sl -~1-03
Date
M:IPEAMITMASTERD000MENTSVd-AF-04