REP00389

• Permit No: M1985173
• IBM Index Class Name: Report
• Doc Date: 1/31/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Kiowa County
M-1985-173
Rother Gravel Pit
February 3, 2003
JAN 3 :1 2003
IXvision ~f Minerals and Geokgy
$688.00 (Due on or before your anniversary date)
I{iowa
_ _ _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 an map s orl~idmg a ex en of curren~dlstuibances'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 annnal report and annnal report map, to this form. 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: Richard McDaniel
Pemtittee Name:
Address:
Phone Number:
Fax Number:
Kiowa County
P.O. Box 100
Eads, CO 81036
[phone]
[phone]
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. Annua] Report instructions are
enclosed.
.~c~t t.~ ~ ~1 ~ C;C
Signature of Corporate Officer, Owner, or Designee
~'d-~-
Date
M:~PERMITMASTERDOCUMENTSU.I-AF-04