2006-04-13_REPORT - M2001087

• Permit No: M2001087
• IBM Index Class Name: Report
• Doc Date: 4/13/2006
• Doc Name: Annual Fee/Report/Map
• From: Fremont County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUN'T'Y:
/ ANNTiAT, FFF, and RF,PnRT RFOTiF,ST
/~ F,remont County
a/M-2001-087
Indian Springs Park Pit
February 11, 2006
RECE~~EC
APR 13 2006
~%Didsba of Niaerah ~ y
$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 £ee, a report and map showing the extent of current dis±urbances 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 your revised written annual re„part and anm~al rennrt maw to this form. Please note that an
adequately Zabeled 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: Paul Garrett
Permittee Name: Fremont County
Address: 615 Macon Ave., Room 105
Canon City, CO 81212
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
Date
M:~PERM ITMASTERDOCUMENTS Wi-AF-04