2005-01-27_REPORT - M1981004

• Permit No: M1981004
• IBM Index Class Name: Report
• Doc Date: 1/27/2005
• Doc Name: Annual Fee/Report/Map
• From: Dilleys Sand & Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~,I'S
17
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dilleys Sand & Gravel
M-1981-004
Ayers Pit
February 2, 2005
~~

JAU 2 -~ 2Gu5
Zivisivn at Pllinarals & GealaGY
$281.00 (Due on or before your anniversary date)
Morgan
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~he_annnal fee,_a_reporLand_map_showing_the-extent-ef-current-distuebturees-ta-a#'feeted-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 ym~r revised written anneal re,Pnrf and anneal rennrt maw to thic 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: Vemon Dilley
Permittee Name: Dilleys Sand & Gravel
Address: P.O. Box 125
1914 Edmunds St.
Brush, CO 80723
Phone Number: [phone]
Fax Number: [phone] ___ _ _____ __ -.~.-
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Si ature of Corporate Officer, Owner r Designee
/- a~-o s
Date