REP15323

• Permit No: M1987186
• IBM Index Class Name: Report
• Doc Date: 2/20/2004
• Doc Name: Annual Fee/Report Notice
• From: Weld County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

U n~G~~
RECEIVED
FEB 2 0 2004
PERMTITEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Weld County
M-1987-186 .~
Peters Pit No 2
March 1, 2004
Division of Minerals & GeoloBY
$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
- - -IanJ, 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 your revised written annnnl rennrt and anm~al re,Pnrt man 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:
Permittee Name:
Address:
Phone Number:
Fax Number:
Greg Nelson
Weld County
P. O. Box 758
Greeley, CO 80632
[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.
ignature f Corporate Officer, Owner, or Designee
x/9/b y
Date
M:~PERM7'IIMASTERDOCUMENTSUI-AF-Oa