2003-09-29_REPORT - M1990016

• Permit No: M1990016
• 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

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
RECEi~/E~
ANNiIAi, FF.F. and RF.PnRT RF.niiF.ST
SEP 2 92003
High Plains Stone Company
M-1990-016
South 40 Quarry
July 11, 2003
Division of Minerals end Geology
$281.00 (Due on or before your anniversary date)
Fremont
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 - I
shall submit the annual fee, a report and map showing the extent of current disturbances [o affected land,
recla~xtatibrt-acc~fmplish~d'ro date and during the preceding year, new disturbances tha are an icipated to occur I
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 anneal re~nrt and anneal re~Qrt mad 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: Scott Wagner
Permittee Name: High Plains Stone Company
Address: P.O. Box 100
Phone Number:
Fax Number:
Castle Rock, CO 80104
[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.
c-o-ems ~-
St re of Corporate O c r, Owner, or Designee
- ~5-O
Date
M:V+ERM ITVdASTER DOCUM ENTSUI-AF-OI