REP31707

• Permit No: M1982131
• IBM Index Class Name: Report
• Doc Date: 8/12/2002
• Doc Name: 2002 Annual Report
• From: Bucklen Equipment Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

t7
ANNUAL FEE and REPORT REQUEST
RECEIVED
AUG 1 2:20pp
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Bucklen Equipment Company
M-1982-131
Bucklen Equipment Co
September 20, 2002
Division at Minerals and Geology
$688.00 (Due on or before your anniversary date)
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-feera_cepnrt..and_map_showing_the_extent_o~current_disturhances 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, [he dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual resort mao to this form. Please note that an
adequately Labeled map that clearly delineates mid 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: Dawn Bucklen
Permittee Name: Bucklen Equipment Company
Address: 804 N. 25th Ave,
Greeley, CO 80631
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information [hat should be provided [o the Division, please provide it
belgwsor attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
~~/b~
Date
M t~PERMITNIASTERDOCUMENTSUI-AF-01