2005-08-23_REPORT - M1992038

• Permit No: M1992038
• IBM Index Class Name: Report
• Doc Date: 8/23/2005
• Doc Name: Annual Fee/Report/Map
• From: Reams Construction Co.
• To: DMG
• Media Type: D
• Archive: No

Aa ~i~~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~a~nn
Jones Fine Sand
1i I-1992-038
Sand Creek Mine
September 1, 2005
~~
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r Auc 2 s 2005
tlluisi00 oV pRino~ala ~ G0o164V
$688.00 (Due on or before your anniversary date)
Adams
Atcordingto-C-:R:S-34=32.5=1'.5 oi`C;R:S.'34~2=YI6; each year, on the anmversary~ate`of t ie ermit, an operator
shall submit the annual fee, 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,ynnr revised written anm~al re~nrt and anm~al rennet map M 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: Doren Palizzi
Permittee Name: Jones Fine Sand
Address: 5400 Forest St.
Commerce City, CO 80022
-I'ho`ne 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.
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Signature of Corporate Officer, Own , o esignee
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Date