2006-07-17_REPORT - M1983112

• Permit No: M1983112
• IBM Index Class Name: Report
• Doc Date: 7/17/2006
• Doc Name: Annual Fee/Report/Map
• From: DMG
• To: Kiowa County
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
I{iowa County
`/M-1983-115
Blackwell Gravel Pit
August 25, 2006
RECE@~E®
~JUL 17 2006
ion of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Prowers
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
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 since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Allen W. Watts
Permittee Name:
Address:
Phone Number:
Fax Number:
Kiowa County
P.O. Box 100
Eads, CO 81036
[phone]
[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

Dale
M:~PERMITMASTERDOCUMENTS~M-AF-04