REP37124

• Permit No: M1977153
• IBM Index Class Name: Report
• Doc Date: 1/19/2005
• Doc Name: Annual Report and Fee
• From: Denver Water Department
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITT'E5 N.9ME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Denvee Water Department
M-1977-153
Reclamation Pit No 1
February 7, 2005
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X688.00 (Doe an or before your anniversary date)
Adams
REGEIVE®
JAN 19 2~
Division of Minerals and Geology
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 begirming
of active operations, and the date active operations ceased for the year, if any.
Plence attnrh_ynnr revised written annnal report and nnnnnl ~ nrt miip, to thin form please note that an
adequately labeled map that clearly delineates and includes the above elements may su„Qice for a mitten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Penrattee Contact: Michael L. Walker
Permittee Name: Denver Water Department
Address: 1600 W. 12th Ave.
Denver, CO 80204
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.
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Signature of Corporate Officer, Owner, or Designee
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Date