REP41964

• Permit No: M1995009
• IBM Index Class Name: Report
• Doc Date: 4/1/2004
• Doc Name: 2004 Annual Report
• From: Fisher Sand and Gravel Co.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

a

RECES' .
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fisher Sand and Gravel Co.
M-1995-009
Fosse Pit
Apri15, 2004
$688.00 (Due on or before your anniversary date)
Kit Carson
APR 01 2004
Division pf Minermo a G@piop~p
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_suhmit _the_annual-fee, a report- and--map-showing -the extent of- cen•ent 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 ynnr revised written annnal report and annnal 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: Ray Leahy
Permittee Name: Fisher Sand and Gravel Co.
Address: P.O. Box 1120
Spearfish, SD 57783
Phone Number: [phone]
Fax Number: [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.
Signature of or or to Offic caner, or Desi ee
/t1 /~ 12.E h/ 2 °(~ 2, o o ~/
Date