2003-12-12_REPORT - M1984041

• Permit No: M1984041
• IBM Index Class Name: Report
• Doc Date: 12/12/2003
• Doc Name: Annual Fee/Report Notice
• From: DMG
• To: American Gypsum Company
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

1 ~.J

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
American Gypsum Company
M-1984-041
Eagle-Gypsum Mine
December 24, 2003
DEC 1 22003
9irision of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Eagle
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, areport- and map showing-the-extent-occurrent-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 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 ynnr revised written annual report and anneal rennrt 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: Stephen A. Onorofskie
Permittee Name: American Gypsum Company
Address: 740 U.S. Hwy 6
Gypsum, CO 81637
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 are enclosed.
W
Signature of Corp to Officer, Owner, or Designee
/2 ~ g• o
Date
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