2002-12-05_REPORT - M1977283

• Permit No: M1977283
• IBM Index Class Name: Report
• Doc Date: 12/5/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

I~ ~ FaECEIVED
NOV 1 5 2002
PUBLIC WORKS ADMitl.
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNPJERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

ANNUAL FEE and REPORT REQUEST
Adams County
M-1977-283
Debetz Pit
December 21, 2002
RECFI!!ED
OEC 0 5 2002
DIYisian if Minerals and Geology
$688.00 (Due on or before your anniversary date}
Adams
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 c tstarbances that are antrcipate3 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 map to this form. Please note that an
adequately labeled mnp that clearly delineates and includes the above elements may suffice far a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Craig Tessmer
Permittee Name: Adams County
Address: 4955 E. 74th Ave.
Commerce City, CO 80022
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to [he Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
of rporate Officer, Owner, or Designee
Dale
M:~PERM I7lMASTERD000M ENTSN~I-AF-04