2004-05-13_REPORT - M1999040

• Permit No: M1999040
• IBM Index Class Name: Report
• Doc Date: 5/13/2004
• Doc Name: Annual Fee/Report/Map
• From: Rio Blanco 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:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Rio Blanco County
M-1999-040
Red Wash Gravel Pit
May 17, 2004
MAY 13 2004
Division of Minerals & GeoloOY
$281.00 (Due on or before your anniversary date)
Rio Blanco
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
°`dper`ator shall sub`mifthe annual fee, a report and map showing the ex[ent-of~current-disnubance~ 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 y!ryir revised written annual rennrt and anmral rennrt maT to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the fallowing petrnittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Jeny Steele
Rio Blanco County
570 2nd St.
Meeker, CO 81641
[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. Annual Report instructions are
enclosed.
Si re of Co rate facer, Owner, or Designee
~-zo-off
Date
M:~PERMITMA57ERD000MENTSNI-AF-04