2002-02-01_REPORT - M1989056

• Permit No: M1989056
• IBM Index Class Name: Report
• Doc Date: 2/1/2002
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIiillllli III ~
999
ANNUAL FEE and REPORT REQUEST
RECD"'''=D
PERMITTEE: NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEiE DUE:
COUNTY:
Don Kehn Construction, Inc.
M-1989-056
Timnath Pit
February 24, 2002
$688.00 (Due on or before your anniversary date)
Lorimer
FEB , t ~s;U1
•(olsion of Minttrala and Ceolayr
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, 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 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 m1
ndequntely lni~eled mnp thnt c[enrly delineates and inc/odes the above elements mm~ since fnr n ~critten report.
Division records indicate [he following perntittee contact information. Please verify and make any necessary
chances:
Permittee Contact: Don Kehn
Permittee Name: Don Kehn Construction, Inc.
Address: 6550 S. County Rd. 5
Ft Collins, CO 80528
Phone Number: (970) 226-41 I I
Fax Number: (970) 226-~1 l 15
if you have additional comments and/or information thaC should be provided [o the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instntctions are enclosed.
Signature of Corporate Officer or Owner
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Date
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