2003-09-11_REPORT - M2000052

• Permit No: M2000052
• IBM Index Class Name: Report
• Doc Date: 9/11/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVE®
SEP 1 1 2003
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNTiAT, FFF, and RF.P(TRT RR(TiiRS'l~wision ~f Minerals and Geology
Rocky Mountain Materials & Asphalt, Inc.
M-2000-052
Coyote Ridge
September 11, 2003
$688.00 (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 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 ymir revised written anneal rennrt and anneal rennrt mad 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: Tom Smith
Permittee Name: Rocky Mountain Materials & Asphalt, Inc.
Address: 1910 Rand Ave.
Colorado Springs, CO 80906
Phone Number: [phone] _
~TFax Number: [phone]
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.
~- ~~~
Signature of Corporate Officer, weer or Designee
Date
M:~PERMnVNASTERD000MENTSU1-Ar-01