2005-07-18_REPORT - M1992051

• Permit No: M1992051
• IBM Index Class Name: Report
• Doc Date: 7/18/2005
• Doc Name: Annual Fee/Report/Map
• From: florence sand and gravel
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Florence Sand & Gravel
M-1992-051
Florence Sand & Gravel Pit
August 11, 2005
$688.00 (Due on or before your anniversary date)
Fremont
JUG 18 2005
Division c; wlirc;cla & GeoiogY
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
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 attaGj~ynnr revised written anneal rennrt and anneal rennrt man to this form. Please note that an
adequately labeled map that clearly de/ineades 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: Del Rodarme]
Permittee Name: Florence Sand & Gravel
Address: 799 5th St.
Penrose, CO 81240
Phone Number: [phone]
Fax Number: (rJ/QJ~g~(-3x41
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, Owner, r Designee
lS-AS'
Date