2011-03-14_REPORT - M1985173

• Permit No: M1985173
• IBM Index Class Name: REPORT
• Doc Date: 3/14/2011
• Doc Name: Annual Fee/Report/Map
• From: Kiowa County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

y
PERM11TEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL Fi?I DUE:
COUNTY:
AN t AL FEE and ' '
R>rlORT REOUF,ST
t Kiowa County
/N1-1985-173
Rother Gravel Pit
February 3, 2011
$$791.00 (Due on or before your anniversary dab)
Kiowa
W
RECEIV
I MAR 14 20fi
Division of FeclamaL,. r
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 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 our revised written annual report and annual report ma 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 ear's may are necessary, then no new ma is re uired rovided that the
O erator shall state this in the Annual Report. Please nose that an adequately laheled map shat clearly
delineates and includes the above elements may suffce.fnr a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Allen Watts
Permittee Name: Kiowa County
Addre=ss: P.O. Box 100
Phone Number:
Fax Number:
Eads, CO 81036
[phone]
[phone]
-ULW?

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. ,,^^?
-. I Way
Signature of Corporate Officer, Owner, or Designee
Date
MAMIUMnWAS7'ERDOC:j)r?lENTS\M.AF q
9/z d
JYb Aml?
50991 « 90482£8£0£ swsa ?L:?L 90-£0-6602