REP36649

• Permit No: M1978266
• IBM Index Class Name: Report
• Doc Date: 8/13/2002
• Doc Name: 2002 Annual Report
• From: DMG
• To: Jackson County
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMPI'I'EE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Jackson County
M-1978-266
Riley Gravel Pit
August 15, 2002
RECEIVED
pUG 13 2002
pig{sign o{ Minerals and Geola9Y
$281.00 (Due on or before your anniversary date)
Jackson
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-snbm3t-the-annual-fee,-a-report-and-map-showing the extent-of--wrrent disrrrbaucesto'affE6 cd
land, reclamation accomplished to date and during the preceding year, new disturbances that aze 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 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: Hazold S. Geer
Permittee Name: Jackson County
Address: P.O. Box 488
Walden, CO 80480
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
Dale v
M:~PERM I7~hIA5TERD000MENTSU~i-AF-04