2004-09-24_REPORT - M1982131

• Permit No: M1982131
• IBM Index Class Name: Report
• Doc Date: 9/24/2004
• Doc Name: Annual Fee/Report/Map
• From: Bucklen Equipment Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~
N~
R€CEIVED
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Bucklen Equipment Company
M-1982-131
Bucklen Equipment Co
September 20, 2004
SEP 24 2004
Dhision ~f fAinerels and Geology
$688.00 (Due on or before your anniversary date)
Weld
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,
reclamation'accomplished-to-date-and=during the-preceding-year, new_disturbances_that_are_anticpated 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.
tease attach }'nor revised written annual re~nrf and annual report main 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: Dawn Bucklen
Permittee Name: Bucklen Equipment Company
Address: 804 N. 25th Ave.
Greeley, CO 80631
Phone Number: [phone]
Fax Number: [phone]
3uo4 MAC
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 ~ rporate Officer, Owner, or Designee
Date