2003-10-30_REPORT - M1980205

• Permit No: M1980205
• IBM Index Class Name: Report
• Doc Date: 10/30/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Select Materials
M-1980-205
Select Materials
RECEI~lE®
OCT 3 0 2Q03
Division of Minerals and Gealagy
October 2, 2003
$688.00 (Due on or before your anniversary date) ~ 5'03 ~~ ~'~ ~/v~
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 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 ynnr revised written anneal report and annual rennrt m,~ 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: Robert D. Oman
Permittee Name:
Address
Phone Number:
Fax Number:
Select Materials
P. O. Box 280
Fort Lupton, CO 80621
[phone]
[phone]
30 3 - ~'S~ - YG a''8
3a3 -857- ~/~3~
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
~~
igna[ure of Corporate Officer, Owner, or Designee
9/~e f~
Date
M:~PERMITMASTERD000MENTSVN-AF-01