2005-10-17_REPORT - M1996031

• Permit No: M1996031
• IBM Index Class Name: Report
• Doc Date: 10/17/2005
• Doc Name: Annual Fee/Report/Map
• From: Sutherland Brothers Inc.
• To: DMG
• Media Type: D
• Archive: No

13-OCT-2005 OBIT FROM-Colorado Divicion of Ninaralc Z Gaoloay H303B326106 T-636 P 002/002 F-66T
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNrvERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
GS erlaud Brothers, Inc.
I-199G-031
Weimer No. Z
July 2, 2005
SSS'
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/~OCT i i 2005
5281.00 (Due on or before your anniversary date)
Montrose
According to C_R.S_ 34-32.5-116 or C.R.S. 3432-L 16, each year, on the aoniversary date of the permit, an operator
shall submit the annual fee, a repon and map showing the extent of current distwbanecs to affected land,
ttclamation accomplished to date and during thc prcccding yeaz, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the begirnting
of active operations, and the date active operations ceased for the year, if any.
Pease attach ynnr rcviced wriffPn 9M11~at rPpnri and annual rPQnit jpgp In this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since jor a written report.
Division records indieere the following permittee contact infomoation. Please verify and make arty necessary
changes'
Permittee Contact: Bob Sutherland
Permittee Name: Sutherland Brothers, Inc.
Address: 29703 Iiwy. 97
Phone Number:
Fax Number:
P.O. Box 889
Nucla, CO 81424
[phone]
[phone]
If you have additional comrrwnts 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 Repoli instructions azc enclosed.
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Signature of Corporate Officer, Owner, or Designee
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Date