2003-10-02_REPORT - M1980135

• Permit No: M1980135
• IBM Index Class Name: Report
• Doc Date: 10/2/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Western Cleanup Corporation
M-1980-135
Headley Farms
October 7, 2003
$688.00 (Due on or before your anniversary date)
Morgan
RECEIVE
OCj ~ 2 2U03
Division of Minerals and Geology
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
shell-submit-the--emtuel-£ee-a-report-and-map-showing-the-extent-of current-disturbances to-affected-land;--
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
please attach ^mn• revised written anneal rennrt and anneal reRprt maTtn this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following pertnittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ron Greene
Permittee Name: Western Cleanup Corporation ~1
Address: z 0$ fl~ (-f W~ 3 `f
Fort Morgan, CO 80701
Phone Number: [phone] - - _
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.
~~~
Si mre of Corporate Officer, Owner, or Designee
Sit' I (v y 3
Date T
M:~PERMITU4ASTERD000MENTSVv1-AF-01