2005-07-19_REPORT - M1983109

• Permit No: M1983109
• IBM Index Class Name: Report
• Doc Date: 7/19/2005
• Doc Name: Annual Fee/Report/Map
• From: kiowa county
• To: dmg
• Media Type: D
• Archive: No

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ANNiiAT. FF,F, and RF.PnRT RF.QTiRST RECE~'

PERMTITEE NAME: JiJL 19 "~ '
Kiowa County c _ _1
PERMIT NO.: M-1983-109 Division ~t Minera,, . -
OPERATION NAME: Aldrich Gravel Pit
ANNNERSARY DATE: August 25, 2005
ANNUAL FEE DUE: $281.00 (Due on or before your anuiversary date)
COUNTY: IQowa
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
operatorshall-submit-the-annual-fee,-axeport-and-map showing the-extent of current-disturbances to-affected --
land, reclamation accomplished to date and during the preceding year, new disturbances than are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming yeaar, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please a loch y~~r revised written anneal report and anneal repnr m p to this fnrm..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:
Rick Spady
Kiowa County
Permittee Name:
Address:
Phone Number:
Fax Number:
P.O. Box 100
Eads, CO 81036
[phone]
[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.
1
Si afore of Co /rate Of c ,Owner, or Designee
15 ~ ~/8~as
Date
M:IPERMITMASTERDOCUMENTSV\I-AF-04