2005-06-08_REPORT - M2002046

• Permit No: M2002046
• IBM Index Class Name: Report
• Doc Date: 6/8/2005
• Doc Name: Annual Fee/Report Notice
• From: ephemeral resources llc
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Ephemeral Resources, LLC
M-2002-046
D Road Gravel Pit
Apri114, 2005

JUPJ 0 ~ 2005
- ' 'U

$688.00 (Due on or before your anniversary date)
Mesa
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anmiversary 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 yeaz, new disturbances that aze anticipated to occur
during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please atfarh ynnr revised written anm~al rem and anm.ai report m ~ to this form. 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 pemvttee contact information. Please verify and make any necessary
changes:
Permittee Contact: Mark Gardner
Permittee Name: Ephemeral Resources, LLC
Address: 1225 S. 7th St.
Grand Junction, CO 81501
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.
Signature of Corporate Officer, Owner, or Designee
Harold F. Elam, Manager
~~ /~3. az. o o,r
Date ~