REP13427

• Permit No: M1986016
• IBM Index Class Name: Report
• Doc Date: 6/2/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Caldwell Brothers
M-1986-016
Caldwell Brothers 3
June 1, 2003
$688.00 (Due on or before your anniversary date)
Otero
RECEIVED
JUlV 0 2 2G03
Oiuisian ~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, areport 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 yonr revised written anneal renort and anneal report map 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 following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Wayne Caldwell
Permittee Name: Caldwell Brothers
Address: 25026 Rd. 19
Rocky Ford, CO 81067
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 Co orate Officer, Owner, or Designee
s~a ~/a 3
Date
M:\PERMI'MIASTERDOCUMENTS\M-AF-0I