2004-07-22_REPORT - M1986105

• Permit No: M1986105
• IBM Index Class Name: Report
• Doc Date: 7/22/2004
• Doc Name: Annual Fee/Report/Map
• From: Dilleys Sand & Gravel
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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FiEG~EQ~!ED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dilleys Sand & Gravel
M-1986-105
Vondy Pit
August 29, 2004
$281.00 (Due on or before your anniversary date)
Morgan
JUL 2 2 2004
Oivisian of Minerals & Geology
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 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 upeoming~ear; reclamator: that-will-be-perfot~ned-during-the-coming_year,-the_dates~or_the beginning-
ofactive operations, and the date active operations ceased for the year, if any.
Please aitach~nnr revised written annnal re~nrt and anmral re~nrt mar to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Vemon Dilley
Permittee Name: Dilleys Sand & Gravel
Address: 1914 Edmunds St.
P.O. Box 125
Phone Number:
Fax Number:
Brush, CO 80723
[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 this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Offic ,Owner, or Designee
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Date