REP48437

• Permit No: M1983213
• IBM Index Class Name: Report
• Doc Date: 2/20/2004
• Doc Name: Annual Fee/Report Notice
• From: Weld County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Weld County
M-1983-213
Lehr Gravel Pit
March 1, 2004
$688.00 (Due on or before your anniversary date)
Weld
RECEIVED
FEB 2 0 2004
®IYI&1®0 Bt h]lpgtalS & CeoloBY
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-bc 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 ynnr revised written annual rennrt sod anm~al red nrt m ~n to this form- 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:
Permittee Name:
Address:
Phone Number:
Fax Number:
Greg Nelson
Weld County
1111 H St
P. O. Box 758
Greeley, CO 80632
[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.
ignature o orporate Officer, Owner, or Designee
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Date
M:IPERMITNfASTERDOCUhfENTS4M-AF-04
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