2005-08-11_REPORT - M1998065

• Permit No: M1998065
• IBM Index Class Name: Report
• Doc Date: 8/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME: W/ashington County
PERMIT NO.: /fYI-1998-065
OPERATION NAME: Hayes Pit
ANNIVERSARY DATE: September 18, 2005
ANNUAL FEE DUE: $281,00 (Due on or before your anniversary date)
COUN'T'Y: Washington ~
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 XQnr revised written anm~al re~pnrt and annual repn_M morn 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: -+°har~-IEmrt~ _~ ~~r ,~~~2„t~it~~~--c,.~.~to
Permittee Name: Washington County
Address: 150 Ash ~ `3-- O U t~atit.~--~iy
Akron, CO 80720
Phone Number: [phone] ~.7 u !f 2 r~ ~/9--M A~?~ o /~/ ~~ /1/' ~^
Fax Number: [phone] ~; r i IJ /" ~` jy ~4 ~ S ~ /4 ~ cc'S'
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.
Si ature of C orate Officer, Owner, or Designee
Date
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M: ~PERMI7UTA S7ERDOCUMENTSIM-AF-04