2005-09-12_REPORT - M2003052

• Permit No: M2003052
• IBM Index Class Name: Report
• Doc Date: 9/12/2005
• Doc Name: Annual Fee/Report/Map
• From: Carder Inc
• To: DMG
• Media Type: D
• Archive: No

CIF=RFT
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
C/arder,Inc~
GIGI-2003-052
Windy Ridge Pit
September 2, 2005

CEP 1 2 2005
Division of Minerals and Geelog~
$688.00 (Due on or before your anniversary date)
Prowers
IAn
Accoromg to L.K.J. 34-.SZ.J-116 or C.K.J. 34-3Z-11h, each year, on the anmversary Gate of the permu, 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 beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anm~al report and annual r~prt ma_n~tn this form. Please note that an
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:
Permittee Contact: Ron Peterson
Permittee Name: Carder, Inc.
Address: POB 732
Lamar, CO 81052
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 Corporate fficer Owner, or Designee
9- 9-c~ 5~
Date