2009-01-27_REPORT - M1986004

• Permit No: M1986004
• IBM Index Class Name: REPORT
• Doc Date: 1/27/2009
• Doc Name: Annual Fee/Report/Map
• From: Harold Brandstadt
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Harold Brandstadt
M-1986-004 ~~
Brandstadt Rock Pit
January 24, 2009
$323.00 (Due on or before your anniversary date)
Delta
R~C~1'VED
JAN ~ 12009 ~
Division of Reclamation,/
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 fee, a report and map showing the extent of current disturbances to affected land,
_ _ _ __reclamation_accomplished_to-date_and_durinu th~nreceriing~year, nQw dict~~r)~~es_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 The Annual Report
& Fee requirement is not met until we have received the following components: fee. report, and associated
man. If no new disturbances or reclamation have occurred durin the previous vear and no new changes to
the previous year's map are necessary, then no new map is required provided that the Operator shall state
this in the Annual Report. 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: Harold Brandstadt
Permittee Name:
Address:
Harold Brandstadt
20426 G Rd.
Delta, CO 81416
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.
Signature of Corporate Officer, Owner, or Designee
Date