2003-09-29_REPORT - M1978271

• Permit No: M1978271
• IBM Index Class Name: Report
• Doc Date: 9/29/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECE1VEb
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Asphalt Gravel Products, Inc.
M-1978-271
Garrett Pit
October 30, 2003
$688.00 (Due on or before your anniversary date)
Conejos
SEP 2 9~200~3
Division of Mircerels \ d G®olo®y
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
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 annual rennrt and annual report main to thin 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: Rock I. Southway
Permittee Name: Asphalt Gravel Products, Inc.
Address: 117 White Pine Dr.
Alamosa, CO 81101
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 Corporat cer, Owner, or Designee
~r ~~ o~
Date
MiPERM ITVNASTERDOCUMENTSUA-AF-01