2006-08-17_REPORT - M2005060

• Permit No: M2005060
• IBM Index Class Name: Report
• Doc Date: 8/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Weld County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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V ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
v Weld County
~/ M-2005-060
Ashbaugh Gravel Pit
September 30, 2006
$281.00 (Due on or before your anniversary date)
Weld
REC~av~~
`~AUG 17 2006
~ivision of ReGamation,
Mining and Safety
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 fe_e, 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 your revised written annual report and annual report maa 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: Greg Nelson
Permittee Name: Weld County
Address: 1111 H Street
P.O. Box 758
Greeley, CO 80632
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.
Signatur f Corporate Officer, Owner, or Designee
.S' t/ / r/ t/C~
Date
M:~PERMITVNASTERDOCUMENTSVN-AF-04