2002-01-14_REPORT - M1984117

• Permit No: M1984117
• IBM Index Class Name: Report
• Doc Date: 1/14/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAMfi:
PERMIT NO.:
OPERATION NAMI~:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
III IIIIIIIIIIIII III
ANNUAL FEE and REPORT REQUEST
Fremont County
M-1978-096
Coaldale Gravel Pit
RECEIVED
JAN 1 4 2002
January 20, 2002 Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Fremont

According [o 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 ac<;omplished 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 vour revised written annual report and annual report map to this form. Please note that art
adequately labeled strap that clearly delineates and it:c[udes 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: y~.,t„-~~'.^a
Permittee Name: Fremont County
Address: °°.^:-c-va>n~v=
E-etopaAt; C8--8'TZ23
P~j.. Apt 3
F6PU `L tJQ\Qf,C
~1ts ht1,4~N/~~,,~v~
Phone Number: (~L~}.94~-~i~ ~-l~ - ~ ~o" ~3Z~
Fax Number: {7.1~.}94~i~8-- ~t~ - ?.~S ~h~
Tf 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 Ofticer or Ow er
f 1 0l
Date
hi WERMnV.1?.STERD000h1ENT5NI-AF-61