2005-06-15_REPORT - M1987024

• Permit No: M1987024
• IBM Index Class Name: Report
• Doc Date: 6/15/2005
• Doc Name: Annual Fee/Report Notice
• From: western gravel in
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNTVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Western Gravel, Inc.
M-198?-024
Corey Gravel Pit #3
April 17, 2005
$688.00 (Due on or before your anniversary date)
Montrose
JUN 152005
Division of Minerals and Gaalagy
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 upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please. attach your revised written annual report and anneal report man to this form. 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: Judy DeVincentis
Permittee Name: Western Gravel, Inc.
Address: 3001 N. Townsend Ave.
Montrose, CO 81401
Phone Number: [phone]
Fax Number:
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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.
E~/-~-
Si ure o orporate Officer, Owner, or Designee
Date