REP40751

• Permit No: M1976027
• IBM Index Class Name: Report
• Doc Date: 6/2/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

EiECEIVED
JUN 0 2 1003
Division ~f Minerals and Geology
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEF DUE:
COIN"1'Y:
Nielsons, Inc.
M-1976-027
Craig Pit
June 17, 2003
$688.00 (Due on or before your anniversary date)
La Plata
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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 rnur revised written annual rennrt and anneal re~'t man to this form- Please note that on
adeytrately labeled map that clearly delineates and includes the above elements may sufficefor a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Craig Wickstrom
Nielsons, Inc.
22419 CR G
P.O. Box 1660
Cortez, CO 81321
[phone]
[phone]
(9 ~~) s~ s - gyp/ xt !~3
If you have additional comments and/or information that should be provided [o [he 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 Officer, Owner, or Designee
S/3 ~J o 3
Date
M:\PERMITMASTERDOCUMENTSVN-AF-01