2003-01-15_REPORT - M1984117

• Permit No: M1984117
• IBM Index Class Name: Report
• Doc Date: 1/15/2003
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMIT'I'EE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Fremont County
M-1984-117
Fremont Gravel Pit
January 20, 2003
$2$1.00-(Due on or before your anniversary date)
Fremont
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_mapshowing_the_extent_of_cuttent_disturbances_to_affected-_______
land, reclamation accomplished to date and during the preceding year, new disturbances [hat are anticipated [o
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and [he date active operations ceased for the year, if any.
Please attarh ym~r r vis d wri ten ann gal r pnr and anm~al report 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: CF.PRcontact first name CF.PR.contact last name
Permittee Name:
Address:
Phone Number:
Fax Number:
PAUL GARRETT DIST Ili SUPERVISOR
Fremont County
615 Macon Ave 202
Canon City, CO 81212-3311
[phone]
If you have additional comments and/or information that shou]d be provided to the Division, please provide it
below or attach it to this form along with your written repoR and map. Annual Report instmctions are
enclosed.
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Signature of Corporate Officer, Owner, or Designee
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Date
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SAN 151003
Division of Minerals and Gealo9Y
M:IPERMiT1MASiERD000MEMStM-AF-03