2005-09-19_REPORT - M1982131

• Permit No: M1982131
• IBM Index Class Name: Report
• Doc Date: 9/19/2005
• Doc Name: Annual Fee/Report/Map
• From: Bucklen Equipment Company
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANDIIVERSARY DATE:
ANDIUAL FEE DUE:
COL1N1'Y:
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B~cklen Equipment Company ~-r-
v M-1982-131
Bucklen Equipment Co
September 20, 2005
~EP 19 20D5
Oivisian of P/linerls and G^olop~~
$688.00 (Due on or before your anniversary date)
Weld
'~ According to C.R.S~a~ll,6_or_~ R 4 'i4_~7-1 1 fi rash ~Pa~nn thr anni-versary_date-ef 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.
pieace attach your revised written annual rennrf and annnal report m ~n to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may sufface for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: yy'' QQ // ~~ii
Permittee Contact: y f!'ll/s ~ D/'!''l~d~ ,~(/GA/7~
Permittee Name: Bucklen Equipment Company
Address: 804 N. 25th Ave.
Greeley, CO 80631
'~ ~S3 a t7z6
Fax 1`(umber: [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.
~f~
Signature of Corporate fficer, Owner, or Designee
~ -3D- 05
Date