REP27697

• Permit No: M1983213
• IBM Index Class Name: Report
• Doc Date: 2/20/2001
• Doc Name: SALES RECEIPT
• From: DMG
• To: WELD CNTY
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

ANNUAL FEE and REPORT REQUEST
Weld County
M-1983-213
Lehr Gravel Pit
March 1, 2001
$688.00 (Due on or betbre your anniversary date)
Weld
RECEIVED
FEB 2 0 2x01
Division of Minerals and Geology
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he anniversary date of the penni[, an
operator shall s!Ibmit the annual fee, a report and map showing the eaten[ of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
OCCUr dnri++° `h, ~:Jt,ii,~f~.i yeu~, •e.:l. ~-t~t~on that will be performed during the comino .~_ -, r!,c dai', fo; [:~•~
..beginning ofac[ive operations;:and-the ~:,te ~r.l;.,e ~Deratlons ccaseu fur tl~c y.uT, ~i any. „ „ ~ '
E7:iLt BfiSih }'oL_' rP~ISed_WrltteS~:!f!;tl%~ :~L'Jri and annnal report mdR :3 SnG fOriTb n~Ca$? nor: thdl~a!+
adequately labeled Wrap that clearty delineates an~i secludes the above elements may suffice for a wrrtter:
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
PennitteeContact: Greg Nelson
Permittee Name: Weld County
Address: P.O. Boa 758
1111 H St
Greeley, CO 80632
Phone Number: [phone]
Fa.~ 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 f Corporate Officer or Owner
~~~~
Date
M ~PERMIPMASTERDOCUM1fENT5UI-AF-O!