2005-08-01_REPORT - M1993039

• Permit No: M1993039
• IBM Index Class Name: Report
• Doc Date: 8/1/2005
• Doc Name: Annual Fee/Report/Map
• From: city of cripple creek
• To: dmg
• Media Type: D
• Archive: No

PE1tMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
City of Cripple Creek
M-1993-039
Midland Gravel Pit
August 4, 2005
$281.00 (Due on or before your anniversary date)
Teller
to 11~
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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
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 atta~ynnr revised written annnal report and annnal re~nrt m n this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Chip Huffman
Permittee Name: City of Cripple Creek
Address: 207 County Rd. 89
P.O. Box 430
Cripple Creek, CO 80813
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.
Signature of C orate Officer Designee
~- ai- os
Date
M:~PERMITNIASTERDOCUMENTSNI-AF-OM1