REP22606

• Permit No: M1984117
• IBM Index Class Name: Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fremont County
M-1989-084
Oak Creek Gravel Pit
January 20, 2004
Oq:431.43/41. 45~0~ _
RECEIVEC
JAN 212004
Oiwmn of Minerals & Geology
$688.00 (Due on or before your anniversary date)
Fremont
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 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 anm~al red nrt and anmral rennrt m ~n to this form. P/ease 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: Oscar Lee
Permittee Name: Fremont County
Address: Fremont County Commissioners
615 Macon Ave., Room # 105
Canon City, CO 81212
P_honelVumher:- _(7x.9)_276-7320_.
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.
c
~~
Sy~natu~re of Corporate ffic r, Owner, or Designee
Dale
M:NERMITUTASTERDOC UMENTSVvf-AF-00