2004-07-14_REPORT - M1987092

• Permit No: M1987092
• IBM Index Class Name: Report
• Doc Date: 7/14/2004
• Doc Name: Annual Fee/Report/Map
• From: Jordan C. and Jone L. Burdick
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Jordan C. and Jone L. Burdick
M-1987-092
B & G Stone
August 25, 2004
$281.00 (Due on or before your anniversary date)
Larimer
JUL 14 2004
Divisiaa of Miamais & GeolaOY
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 p*ecedinQTyear,-new_disturbances~hatare_anticipated_tn_oceur
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 atta~ynnr revised written annnal re~nnrt and annnal re~nrt main to this form. Please note that an
adequately dabeded 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: Jordan C. Burdick
Permittee Name: Jordan C. and Jone L. Burdick
Address: P.O. Box 1385
Phone Number:
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signa of Corporate Officer, Owner, or Designee
~-x-o ~/
Date
Lyons, CO 80540
[phone]