2006-11-17_REPORT - M1984099

• Permit No: M1984099
• IBM Index Class Name: Report
• Doc Date: 11/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Goose Haven Sand & Gravel, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

r~"~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
c~ ANNUAL FEE and REPORT REQUEST
i/ Goose Haven Sand & Gravet, Inc.
;~M-1984-099
Bailey Ptt
September 29, 2006
RECEIVED
~NOV 17 2006
'Division of Reclamation,
Mining and Safety
$688.00 (Due ou or before your anniversary date)
Weld
I ~~ ~
According to C.R.S. 34-32.5-1 l6 or C.R.S. 34-32-I 16, each yeaz, on the anniversary date of the permit, an operator
- - - ---shall -submit- the-armual fee; a-report and-mag showing the -extent rof current-disturbances -to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occw
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 vour revised written annual report and annual report map to this form. The Annual Report &
Fee requirement is not met until we Lave received the following components: fee, report, and associated maa
(All are required regardless of the level of disturbance or absence of disturbance during the previous year).
Please note that an adequately labeled map that clearly delineates and includes the above elements may suffece for
a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Doug Tiefel
Permittee Name: Goose Haven Sand & Gravel, Inc.
Address: P.O. Box 17130
Boulder, CO 80308
Phone Number: [phone]
Fax Number: [phone]
~ w~t a~,r•~, vter~ ~,~
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 aze enclosed.
Signatwe of Corporate Officer, Owner, or Designee
~~114/06
Date