2002-01-04_REPORT - M1977283

• Permit No: M1977283
• IBM Index Class Name: Report
• Doc Date: 1/4/2002
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMI'ITEE NAME:
PERMfi' NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Adams County
M-1977-283
Debetz Pit
December 21, 2001
RECEIV'E~~
JAN 0 4 2002
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Adams
According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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 [he preceding year, new disturbances that are anticipated [o
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 mote that an
adequately labeled map that clearly delineates and includes the above elements may suj~ce jor a written
report.
Division records indicate the following permittee contact information. Please verify and m.tke any necessary
changes:
Permi[[ee Contact: Craig Tessmer
Permittee Name: Adams County
Address: -9~5-H- 'F`t55 E, 7`ti~ Aye.
Commerce City. CO 80022
Phone Number: [phone]
Fax Number: [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.
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Signature orporate Officer or Owner
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