2009-09-24_REPORT - M2003016

• Permit No: M2003016
• IBM Index Class Name: REPORT
• Doc Date: 9/24/2009
• Doc Name: Annual Fee/Report/Map
• From: SW Chambers
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

SEP-23-2009 11:16AM FROM-OIV RECLAMATION MINING & SAFETY [phone] T-118 P.003/003 F-438
f ?7
L VE
d REPORT RE
E T
i
an
UA
A1VN
OU

PERMITTEE NAME: \ W Chambers, LLC
PERMIT NO.: `x(,2003-016
OPERATION NAME: Hcit Sand and Gravel Mine 40
ANNIVERSARY DATE: September 27, 2009
ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date)
COUNTY: Weld

--.
4
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 r(;.-port 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 map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
may). If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous Year's man are necessary, then no new man is required, provided that the Operator shall state
this in the Annual Report. Please note that an adeq-tiately labeled map that clearly delineates and includes the
above elements may sufflice for a tivi•itten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittec Contact: ark D. Campbell
PermitteeName: SW C %jn r s, C
Address: 7600E a Rd, Ste 370•S

Greenwidod Villai-ACO 80111
Phone Number: [phone]
Fax Number:
-5 In-2

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 ?nap. Annual Report instructions are enclosed.
P%EAS? sue, ?t?????r}! F?? 19?-v-o i2CPn2T f'??7- To PrfJ.r/
A 17/3-cIf r-b z- u? v o P i o e Th'1s -71
??,?G .
Signature orp to Officer er, or Designee
l Pr ti??? Ago coy-rPn.vy ,.??Je,
04TO