2006-01-23_REPORT - M2003037

• Permit No: M2003037
• IBM Index Class Name: Report
• Doc Date: 1/23/2006
• Doc Name: Annual Fee/Report/Map
• From: Sky Ute Sand & Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PF..RMriTfifi NAME:
PSRMff NO.:
OPFItAT10N NAME:
ANNIV}'sRSARY DATE:
AN1V[JAL Ffifi bIJE:
COUNTY:
fv~ RECEIVED J
JAN 2 3 2006
Olvtslm~ „~ minerals and Geology
Haldoraon and Sona, Inc-
h-2003-037
Haldorson Sand and 4ravei l1i)pe
December 16, 2005
$688.00 (Dne on or before yonr anniversary date)
Montroac
According to C.R.S. 3432.5-11G or C.R.S. 34-32-116, each year, on the anniversary date of the permtt, an operator
shaD submit the aiintial fee, a iepot~ i0izrlfla¢-shbwirrg the tztt~r[t oF~cnmrtrt disturba[rcea to-aff~ted-land-
reclamation accompll5hed to date end during the preceding year, new dieturbeneee that arc anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beghming
of active oporatione, and the date active operations ceased for rho year, if any.
Pl~se aHAC~INir lrevlaad wrMfTn annual rnonrt and annnp~~n m p to th:a.fnrm_ Please Hole that an
adequately labeled map that clearly delineates and includes the above elements mdy st~ice for a written report.
Division records indicate the following petmittee contact information. Please verify and make any necesaery
changes:
Pormittce Contact: Mark Flaldarsan
Permittee Name: Haldoraoo and Sans, Inc.
Address: P.O. Aoz 1019
Montrose, CO 81402
Phone Number: [phone]
Fax Number: [phone]
J l~'~ 1A~iPl ~,c~]l,~ ~ -Fa Arm
If you have additional aommenu+ and/or information that should be provided m the Division, please provide it
below or attach it to this form along with your written report and map. Annuat Report instructions arc rnclosed.
Sim of Corporate Offrccr, Ownor, or Designee
~°,% ~ro s
bate