2002-12-12_REPORT - M2000092

• Permit No: M2000092
• IBM Index Class Name: Report
• Doc Date: 12/12/2002
• Doc Name: Annual Fee/Report Notice
• 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:
ANNUAL FEE and REPORT REQUEST
City of Walsenburg
M-2000-092
Walsenburg Gravel Pit
December 14, 2002
$281.00 (Due on or before your anniversary date)
Huerfano
RECE9VED
DEC f 2 2002
Division of Minerals and Ge0ltt~y
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,, reclamalion accomp isheil t~aie a~~6cing the preceding year, new3ist`urbances t at~icipated to
occur during the upcoming year, reclamation [hat 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 report and annual report map to this form. Please note that an
adequately Labeled map that clearly delineates and Includes the above eletnents may since for a written
report.
Division records indicate the following perntittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Fre~P~-l~edridaez~
Permittee Name: City of Walsenburg
Address: 525 S. Albert
Walsenburg, CO 8I089
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.

Signature of Corporate Officer, Owner, or Designee
i~-~ ~Z.
Date
M iPERM17VNASTERD000MENTSN4-AF-04