2004-10-21_REPORT - M1981013

• Permit No: M1981013
• IBM Index Class Name: Report
• Doc Date: 10/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Nichols Gravel Pit L.L.P.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~s~
~~~~
~~~~~~~®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Nichols Gravel Pit, L.L.P.
M-1981-013
Nichols Gravel Pit
October 21, 2004
OCT 21 ?004
Ofuiaion of P4i~.erak; iy OAaIA®V
$688.00 (Due on or before your anniversary date)
Mesa
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 opeiafor
_ _ shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
. .- .. .reclamation aecomplished to .date: and during the_preceding.year, new disturbances_that_are ant_icipated3o-occur~_
during the upcoming yeaz, 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 annual report and annnal report man to this fnrm_ Please note that an
adequately labeled map that clearly delineates 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: John Nichols
Permittee Name: Nichols Gravel Pit, L.L.P.
Address: P.O. Bax 285
Phone Number:
Eax Number:
Mesa, CO 81643
[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~his form along with your written report and map. Annual Report instructions are enclosed.
of Corporate Officer, Owner, or Designee
Date