2005-10-28_REPORT - M1995038

• Permit No: M1995038
• IBM Index Class Name: Report
• Doc Date: 10/28/2005
• Doc Name: Annual Fee/Report/Map
• From: Haldorson and Sons Inc.
• To: DMG
• Media Type: D
• Archive: No

~~,~ J \ ~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
' Haldorson and Sons, Inc.
~M-1995-038
Spor Pit
October 30, 2005
$281.00 (Due on or before your anniversary date)
San Miguel
RECEIVED
OCT 2 8 2005
`t`Divisiun of wuuerais a~.o neology
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~armual-fee,-a-.r°port-attd ,. . t d:stcnbmzees=e off et..d-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 ynnr revised written anneal report and anneal report m ~n to Chic 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: Mark S. Haldorson
Permittee Name: Haldorson and Sons, Inc.
Address: P.O. Box 1019
Montrose, CO 81402
Phone Number: [phone]
Fax Number:
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.
Signature of Corporate Officer, Owner, or Designee
Date