2006-03-01_REPORT - M1987186

• Permit No: M1987186
• IBM Index Class Name: Report
• Doc Date: 3/1/2006
• Doc Name: Annual Fee/Report/Map
• From: Weld County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
(,/ ANIViiA1, FF,F. and REPORT RF.QiTRST
l/ Weld County
M-1987-186
Peters Pit No 2
March 1, 2006
RECEIVE®
" MAR 0 `a 2006
/D~~ pf Minerals antl Geolo9Y
$688.00 (Due on or before your anniversary date)
Weld
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
------accur~urirrg-the-upcoming-year,-reclamation°thatZVilt-be'p~rfartnezT-duri~-the-`coming year-the~ates for~fie` beginning of active operations, and the date active operations ceased for the year, if any.
Please attach xnnr revised written annual reRnrt and annual report main, [n [hic form. Please note that alt
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:
Phone Number:
Fax Number:
Greg Nelson
Weld County
1111 H St.
P.O. Box 758
Greeley, CO 80632
[phone]
[phone]
~47~) 3Orl~-~~19(o v'
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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 orporate Officer, Owner, or Designee
.~/off 7 ~ G
Date
M:~PERMITVNASTERDOCl1MENT5UI-AF-04