2005-06-16_REPORT - M2000073

• Permit No: M2000073
• IBM Index Class Name: Report
• Doc Date: 6/16/2005
• Doc Name: Annual Fee/Report Notice
• From: rio blanco county
• To: dmg
• Media Type: D
• Archive: No

I~E~EIVE®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNTiAT. FF.F. and REPORT RF,OTTFST
Rio Blanco County
M-2000-073 ~jyy~
Shults Gravel Pit
June 27, 2005
JUN i g 20~
Diviai¢n of Minerals and G¢al¢gy
$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
operator-shall-submiEtlre-skfee,=earepast-and-reap=showing.the-extent=of-cuuent_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.
Pleat atta h Yonr rrviaed written anneal report and anneal report m n 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: ~-
Permittee Name: Rio Blanco County
Address: S70 2nd St.
Meeker, CO 81641
Phone Number: (970) 8~56E}I'
Fax Number: [phone]
Tea d ~ d M.a r~t-ary
g78- g5gt,
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 e of Corporat Of ter, Owner, or Designee
Date
M:~PERhIITN1ASTERDOCUMENTSNI-AF-04