2005-09-02_REPORT - M1987097

• Permit No: M1987097
• IBM Index Class Name: Report
• Doc Date: 9/2/2005
• Doc Name: Annual Fee/Report/Map
• From: Conejos County
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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~P 0 ~ 2005
~l3ivision of Minerals and Ceolopv
Conejos County
(/M-1987-097
La Florida Gravel Pit
August 18, 2005
$281.00 (Due on or before your anniversary date)
Conejos
Ica
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
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 vrnur revised written annnal rennrt and anmlal re,Pnrt mad to this form. Please note that an
adequately labeled map that clearly delinentes 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: Bob Lucero
Permittee Name: Conejos County
Address: 6683 County Rd. 13
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P O Box 157
Conejos, CO 81129
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 ate
enclosed.
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Signature of Corporate Officer, Owner, or Designee
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Date
M:~PERMITIMASTERDOCUMENTSIM-AF-PO