2001-06-05_REPORT - M1990016

• Permit No: M1990016
• IBM Index Class Name: Report
• Doc Date: 6/5/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

~ iii iiiiiiiiii~uii~ ~
ANNUAL FEE and REPORT REpUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
High Plains Stone Company
M-1990-016
South 40 Quarry
July 11, 2001
REC"
rIVED
JUN 0 5 2001
Oivisian of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Fremont
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 u, 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 [he
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note thnt nn
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: Scott Wagner
Permittee Name: High Plains Slone Company
Address: P.O. Box 100
Castle Rock, CO 80104
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.
1.t7~~
Signature of Corporate Of cer or Owner
(o-y-b)
Date
M:~PERM rM7ASTERD000MEm'SV.7-AF-01