REP30230

• Permit No: M1992049
• IBM Index Class Name: Report
• Doc Date: 7/11/2002
• Doc Name: 2002 Annual Report
• From: Peck Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST

ABo~oag pue s~eiamW }o uois~ni0
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE;
COUNTY:
Peck Inc.
M-1992-049
Peck Pit
July 13, 2002
tCOa < < ~nr
a3na3~3a
$281.00 (Due on or before your anniversary date)
Ouray
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_ annuaLfee,_a_report_and_map_showing the extent-of-current disturbances-tc-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 yeaz, if any.
Please attach vour revised written annual report and annual report mao to this form. Please Wore 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: Chazles R. Ponchak
Permittee Name: Peck Inc.
Address: P.O. Boxes G' „oq'p
a78 ~~~.
Ouray, CO 81427
Phone Number: [phone]
Fax Number:
~Or !~~'~ v27~'
9~0 --a y9 -- ~i4 3 ~
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 Corporate Officer or Owner
7- 7-OZ
Date
M iPERMI'[ V.IASTERD000MEMSUI-AF-01