2007-03-12_REPORT - M1982126

• Permit No: M1982126
• IBM Index Class Name: Report
• Doc Date: 3/12/2007
• Doc Name: Annual Fee/Report/Map
• From: Crowley County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and PORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
/Crowley County
-1982-126
Crowley Cnty Grav 2
Apri128, 2007
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$$688.00 (Due on or before your anniversary date)
Crowley
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 your revised written annual report and annual report maa to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated maa. If no new disturbances or reclamation have occurred durinc the arevious vear and no
new chances to the arevious year's maa are necessary. then no new map is required, provided that the
Operator shall state this in the Annual Report. 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:
Permittee Name:
Address:
Mike Apker
Crowley County
603 Main St. Ste. 2
Ordway, CO 81063
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 pr attach it to this form along with your written report and map. Annual Report instructions are
of Corporate Officer, Owner, or Designee
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Date
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