2002-12-03_REPORT - M1987166

• Permit No: M1987166
• IBM Index Class Name: Report
• Doc Date: 12/3/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Westhoff Farms
M-1987-166
Westhoff Farms
December 1, 2002
RECE,VED
DEC 0 3 2002
Division ~f Minerals and Geology
$281.00 (Due on or before your anniversary date)
Morgan
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 [he extent of current disturbances to affected land,
---ceclamafion accomplished to date awn during ttie preceding year, new disturbances that are an[ictpated to occur
during the upcoming year, reclamation that will be performed during the coming year, [he dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual resort and annual report map to 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: Joseph E. Westhoff
Permittee Name: Westhoff Farms
Address: 2823 RD3
Wiggins, CO 80654
Phone Number: [phone]
- - Fax Number: - -(970)-483-5561
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.
Date
M 1PERMCDMASTERD000MENTSNI-AF-01
Designee
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