REP19512

• Permit No: M1995009
• IBM Index Class Name: Report
• Doc Date: 3/28/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

+/
RECElVE®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fisher Sand and Gravel Co.
M-1995-009
False Pit
April 5, 2003
MAR 2 8 1003
Division ~f Minerals and Geology
$688.00 (Due on or before your anniversary date)
Kit Carson
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 curent disturbances to affected land,
reciamation 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 Xqur revised written anneal rennrt and anneal renort map to this form. Please note fhat 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: Ray Leahy
Permittee Name: Fisher Sand and Gravel Co.
Address: P.O. Box 1120
Spearfish, SD 57783
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.
I
Signature orate Of er, Owner, or Desienee
March 22~ 2003
Date
M 1PERMITMASTERDOC UMENTS'M-AF-01