2007-06-29_REPORT - M2003092 - Laserfiche WebLink

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~~; ~~~ ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: Nick H. Gray RECEIVED PERMIT NO.: /M-2003-092 ~ ~~ON ;2 9 ZQQ] OPERATION NAME: Gray Pit #I Division of Keaamation, ./ Mining and Safety ANNIVERSARY DATE: June 29, 2007 ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) COUNTY: Montrose 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 cun•ent disturbances to affected land, reclamation_accomplished_to~iate_and_during_the_preceding_yeac, new_disturbances_thatare_anr±~ipa+P~1 tD_acr~~* 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 vour revised written annual resort apd annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred durinti the previous year and no new chanties to the previous year's map are necessary, then no new map is required. provided that the Operator shall state this in the Annual Report. 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: Nick H. Gray Permittee Name: Address: Nick H. Gray 584 65.30 Rd. Montrose, CO 81401 Phone Number: (970) 249-9436 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. ~gnature of Corporate Officer, Owner, or Designee ~ ~ ~ ~~ Date