2010-02-19_REPORT - M1977256

• Permit No: M1977256
• IBM Index Class Name: REPORT
• Doc Date: 2/19/2010
• Doc Name: Annual Fee/Report/Map
• From: Grand County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

FEETa REPORT REQUEST
PERMITTEE NAME: Gr nd County _
.
_ ?b
PERMIT NO.: -1977-256 cely
OPERATION NAME: Benson Pit re 19 2010
ANNIVERSARY DATE: March 23, 2010 ®IVJM?Jn0f ReclarnatJon,
ANNUAL FEE DUE: $791.00 (Due on or before your anniversary ate) ?` ??fGty
COUNTY: Grand
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 currentdisturbances 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 may 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 chanEes to the previous year's map are necessary, then no new may 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:
Ken Haynes
Grand County
467 E. Topaz Ave.
P.O. BOX 9
Granby, CO 80446
Permittee Name:
Address:
Phone Number:
Fax Number:
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach ' to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corpo Officer, Owner, or Designee
7i ? ZO l t7
Date
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