2004-05-12_REPORT - M1978327

• Permit No: M1978327
• IBM Index Class Name: Report
• Doc Date: 5/12/2004
• Doc Name: Annual Fee/Report/Map
• From: Jake Kauffman & Sons Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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MAY 1 2 2004
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUN"PY:
Jake Kauffman & Son, Iuc
M-1978-327
Kauffman Pit
May 14, 2004
$688.00 (Due ou or before your anniversary date)
Larimer
Di~isien of Minerals & GeolaBY
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,
rec amation aocomplis)led-to-date-and-during-the preceding~yearfnew 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 ymrr revised written anneal report and anneal rennet 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: Mary Kauffman
Permittee Name: Jake Kauffman & Son, Inc
Address: 808 SCR 9E
Loveland, CO 80537
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.
Signa of CCorp to Officer, Owner, or Designee
s' iD a Y
Date