2001-08-09_REPORT - M1982131

• Permit No: M1982131
• IBM Index Class Name: Report
• Doc Date: 8/9/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

999
RECEIVED
ANNUAL FEE and REPORT REOUEST AUG 0 9 2001
PERMITTEE NAME: Bucklen Equipment Company Division of Minerals and Geology
PERMIT NO.: M-1982-131
OPERATION NAME: Bucklen Equipment Co
ANNIVERSARY DATE: September 20,2001
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Weld
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�4gorl 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 map to this form. Please note that at
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
0k
Permittee Contact: Dawn Bucklen
Permittee Name: Bucklen Equipment Company
Address: 804 N. 25th Ave.
Greeley, CO 80631
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 Corporate Officer or Owner
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Date
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