2003-07-03_REPORT - M1997089

• Permit No: M1997089
• IBM Index Class Name: Report
• Doc Date: 7/3/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

v
RECEIVE
JUL 0 3 2003
Oivisio0 ~f Minerals and Geology
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Doren Stone
M-1997-089
Stone Gravel Pit
July 8,2003
$688.00 (Due on or before your anniversary date)
Montezuma
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-that-are-amicipated-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 your revised written annnal rennrt and anmlal rennrt man 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: Doren R. Stone
Permittee Name:
Address:
Phone Number:
Fax Number:
Doren Stone
P.O. Box 483
Cortez, CO 81321
[phone]
- [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.
igna e of Corporate Officer, Owner, or Designee
~ - 3V0- ~~
Date
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