2006-03-01_REPORT - M1980121

• Permit No: M1980121
• IBM Index Class Name: Report
• Doc Date: 3/1/2006
• Doc Name: Annual Fee/Report/Map
• From: Weld County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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`LIAR 012006
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~/ Weld County
M-1980-121
Pierce Pit
March 1, 2006

GepM9Y
pims~on of M~enls Md
$688.00 (Due on or before your anniversary date)
Weld
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 fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anneal refit and anneal repnr m to this form- Please note that an
adeguately 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:
Phone Number:
Fax Number:
Greg Nelson
Weld County
1111 H St
P.O. Box 758
Greeley, CO 80632
[phone]
[phone]
Djl
(~7a) 3o~-by9~ ~
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. Annua] Report instructions are
enclosed.
Signature of orporate Officer, Owner, or Designee
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Date
M: W ERMITMAS7ERDOCUMEMSVvI-AF-09