REP43772

• Permit No: M1989023
• IBM Index Class Name: Report
• Doc Date: 2/1/2002
• Doc Name: Returned Annual Report Notice
• From: DMG
• To: Clyde and Marie Couch
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Clyde and Marie Couch
M-1989-023
Caliche School Pit
March 9, 2002
$281.00 (Due on or before your anniversary date)
Logan
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an o erator _ _
shall submit the annual fee, a report and ma sho n.-~,n.u~~cn is ur antes to affected land,
_~reelamation-accorerplis e to ate and during [he 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 your revised written annual report and annual report map 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 peanittee contact information. Please verify and make any necessary
changes:.
Permittee Contact: Clyde.Coych
Permittee Name: Clyde and'Marie Couch'
Address: 19956 Co Rd # 34
Sterling, CO 80751
Phone Number: [phone]
Fax Number:
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 aze enclosed.
Signature of Corporate Officer or Owner
Date
M:~PERMR V.IASTERDOCUMEMSUI-AFA I