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<br />PERMITTEE NAME: <br />P1iRh~IIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Glader Gravel Products <br />M-1985-001 <br />d&dPit <br />done 27, 200~s <br />5281.00 (Doe on or before your anniversary date) <br />La Plata <br />JUr9 0 ti 2u05 <br />0lvlolon of n9lncmla~, Geology <br />According to C.R.S. 3432.5-116 or C.R.S.-3432-116; each year, on the a~miversazy date ofthe permit, ~ operator <br />shall submit the annual fee, a report and map showing the extent of crarent disturbances to affected land, <br />-, te.~ncLduring the_.rnecpdin~yg~ new distur~tces that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the cornir-g year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />PI s. aftn h pnnr revicwl wriMen annual ~ rt snd annosl r~~rt msp to thia fnrn~_ plpgfg gpte that aA <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittce contact information. Please verify and make any necessary <br />Changes: <br />Permittee Contact: Jim Hehnericks <br />Permittee Name: Glacier Gravel Ptvducts <br />Address: 995 Hwy. 3 <br />Durango, CO 81301 <br />= Phone-Number.=~-=(970)-259=3995- - <br />Fax Number: (970) 375-7880 <br />If you ]rave,~dditional commetds and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Sign~ature~of~Co~r'porate Officer, er, or Designee <br />