2002-12-09_REPORT - M1978249

• Permit No: M1978249
• IBM Index Class Name: Report
• Doc Date: 12/9/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
DEC 0 9 2002
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Logan County
M-1978-249
Kokes Gravel Pit
October 1, 2002
RECEIVE®
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Logan
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 s'-1-iall subrrfiT ttte-annnal-fee,-a-report-and-map~howing_[he_extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o
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 your revised written annual reuort and annual resort map to this form. Please note that an
adegaately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: -iz ~ viTOso.~
Permittee Name: Logan County
Address: 315 Main St.
Sterling, CO 80751
Phone Number:_ _ [phone] ^
Fax Number: [phone]
~yroh l~ic-Cox
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 Off' er, Owner, or Designee
//~ao,0~
Dale
M9PER MnN1ASTERD000MEMSN1-Ar-04