REP32502

• Permit No: M2001010
• IBM Index Class Name: Report
• Doc Date: 8/4/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
AUG 0 4 2003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Elbcrt County
M-2001-010
Allison Gravel Pit
August 14, 2003
$688.00 (Due on or before your anniversary date)
Elbert
Oirision ~l Minerals and Geology
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 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 year revised written anneal report and anneal report m ~n 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: Tim Sheridan
Permittee Name: Elbert County
Address: 809 Ute Ave.
Simla, CO 80835
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.
~~
Signature o rporate O tcer, Owner, or Designee
Q~ ~~ ~ ~
Date `
M:IPERMITVNASTERDOCUMENTSVN-AF-04