2005-09-21_REPORT - M1979166

• Permit No: M1979166
• IBM Index Class Name: Report
• Doc Date: 9/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Elam Construction Inc
• To: DMG
• Media Type: D
• Archive: No

S'SS'
~~ ~ ~~ ~ RECEIVED AuG 12005
ANNUAi, FF.F, and RF.PnRT RF. 70 IFCT
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~E/lam Construction, Inc.
~'M-1979-166
BennetYs Gravel Pit
September 4, 2005
n ~~~~:~ ~f~~
-r/V! ~EF 2 ? 2005
$688.00 (Due on or before your anniversary date)
Delta
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

-shalt-submit-the-annual-fee;~repo an mad- o mg a"-th extent of-current istur ances 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 ym~r revised written annnal re~nrt and annnal re,~nrt 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: Hazold F. Elam
Permittee Name: Elam Construction, Inc.
Address: 1225 S. 7th St.
Grand Junction, CO 81501
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.
/iY ~+~+~
Signat of Corporate ficer, Owner, r Designee
y- , s
Date