2005-11-21_REPORT - M1977205

• Permit No: M1977205
• IBM Index Class Name: Report
• Doc Date: 11/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Tri County Gravel
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNiiAi, FF.F, and RF,P(iRT RF.t7iiF.RT
T//ri County Gravel
t/M-1977-205
Tri-County Gravel
November 29, 2005
SSS
RECEIVED
~1 ~ov z t 20~
r v0irision of Minerals and Geolopq
$688.00 (Due on or before your anniversary date)
Delta
-According-to_C.R S_34-32.5-1-1.6.or_C.R,S,-?4-?2-1-16,-each-year,,on-the anniversary-date of-the-permrt; anoperator -
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 Xnnr revised written annual rennet and anneal rennet maw 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: Richard E. Curry
Permittee Name: Tri County Gravel
Address: P.O. Box 566
Hotchkiss, CO 81419
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 of Corp rate Officer, Owner or Designee

Date