2007-02-23_REPORT - M1981286

• Permit No: M1981286
• IBM Index Class Name: Report
• Doc Date: 2/23/2007
• Doc Name: Annual Fee/Report/Map
• From: Weld County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REOUE5T
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Weld County
M-1981-286
Thomas Gravel Pit 4
March 1, 2007

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$$688.00 (Due on or before your anniversary date)
Weld
y 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
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 vour revised written annual resort and annual resort map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, reuort, and
associated maa. If no new disturbances or reclamation have occurred during the previous vear and no
new chances to the previous year's map are necessary, then no new map is required, nrovided that the
Operator shall state this in the Annual Renort. 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: Greg Nelson
Permittee Name: Weld County
Address: 1111 H St.
P.O. Box 758
Greeley, CO 80632
Phone Number: [phone]
Fax Number: [phone]
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If you have additional cottunents 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 C orate Officer, Owner, or Designee
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Date
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