2011-02-11_REPORT - M1981236

• Permit No: M1981236
• IBM Index Class Name: REPORT
• Doc Date: 2/11/2011
• Doc Name: Annual Fee/Report/Map
• From: Raymond C Petersen
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
?P' F- + YCI? /
ANNUAL FEE and REPORT RE UEST
Raymond C. Petersen
M-1981-236
Colorado River Ranch Gravel Pit
March 29, 2011
RECEIV
tl'FEB 1112 011
Division of Reclamation,
Refining and Safety
$791.00 (Due on or before your anniversary date)
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 s" ,,the extent _ o current cteL La ad -
Efic g, ne i r icipa e d'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
man. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous vear's man are necessarv, then no new man 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 suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address
Raymond C. Petersen
Raymond C. Petersen
P.O. Box 832
Kremmling, CO 80459
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
bej19 -zr attach it to this form along with your written report and map. Annual Report instructions are enclosed.
of Corporate Officer, Owner, or Designee
"February 10, 2011
Date