REP04195

• Permit No: M1981085
• IBM Index Class Name: Report
• Doc Date: 7/11/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
N Colo Water Conservancy Dist
M-1981-085
Riprap Quarry Area
July 21,2003
$688.00 (Due on or before your anniversary date)
Grand
JUL 1 1 2003
Division ~f Minerals and Geology
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-rectamation-accomplished to date and during~the preceding year, new-disturbances thaCare anticipated to
occur during the upcoming year, reclamation that will be performed during [he coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attac~ynnr revised written annual repnH and annnal re Dr m 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: Jerry A. Westbrook
Permittee Name: N Colo Water Conservancy Dist
Address: P.O. Box 679
Loveland, CO 80539
-- Phone-Number'. -(970)-667=2437 --
Fax Number: [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. Annual Report instructions are
enclosed.
Officer, Owner, hr Designee
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Date
M:IPERMITVv1AS7ERD000MENTSVd-AF-06