2006-08-24_REPORT - M1984155

• Permit No: M1984155
• IBM Index Class Name: Report
• Doc Date: 8/24/2006
• Doc Name: Annual Fee/Report/Map
• From: Dolores County
• To: DRMS
• 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:
COUNTY:
~/ ANNUAL FEE and REPORT REQUEST
(/ Dolores County
/ M-1984-155
Bartley Gravel Pit
September 27, 2006
RECEIVED
'~AUG 2 4 2006
~ivision of Reclamation,
Mining and Safety
$688.00 (Due on or before your anniversary date)
Dolores
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 I
6pCratOr-Shail-Submit' uiC amlual' iee~-a-rc i i iia i i wc~i'iZnt-GfZTiii L d '~
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 report and annual resort maa 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:
Permittee Name:
Address:
Tim Huskey
Dolores County
P.O. Box 608
Dove Creek, CO 81324
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.
~/ 1~{~((1 .Lrn
Si ature of Corporate OfficPy, weer, or Designee
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