2004-05-28_REPORT - M2002020

• Permit No: M2002020
• IBM Index Class Name: Report
• Doc Date: 5/28/2004
• Doc Name: Annual Fee/Report/Map
• From: City of Greeley
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
City of Greeley
M-2002-020
25th Avenue Site
May 30, 2004

RECEIVED
MAY 2 g 2x04
Division o1 Minerals and Gao1o8Y
$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 fee, a report and map showing_the~xtent_of current disturl~nc_es_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 vrnur revised written anmral report and anmral repDrt mao to 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: Todd Williams
Permittee Name: City of Greeley
Address:
-- -Phone Number:
Fax Number:
1100 10th St.
Greeley, CO 80631
(970}350-9291
[phone]
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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.
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Signature of Corporate Officer, Owner, or Designee
Date
M:NERMI71A7ASTERDOC[1MENTSV.r-AF-0O