2010-08-18_REPORT - M1994077

• Permit No: M1994077
• IBM Index Class Name: REPORT
• Doc Date: 8/18/2010
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

O 'i 13

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
1
G
ANNUAL FEE and AP RT REQUEST
4
County
;:_as199'ington
4-077
Nickell Gravel Pit
August 25, 2010

RECETVED
AUG 18 2010
4 ivision o Reaamation.
Mining and Sa"
$$791.00 (Due on or before your anniversary date)
Washington
ccd tg C R S. 34 32.5-1.16 or C.R.S. 34-32-116 each ear, on the anniversary date of the permit an
operator shall submit the annual fee, a repo m`ap owing the extent 6 cuireilt dlsurbances fo atlected ""? - -
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 report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee,: fee, report, and
associated map. If no new disturbances or reclamation have occurred no new disturbances or reclamation have occurred duringtheprevious Year and no and no
new changes to the previous vear's map are necessary, then no new map is required, provided that the
Operator shall state this in the Annual shall state this in the Annual Report. 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: Don Riemenschneider
Permittee Name: Washington County
Address: 150 Ash Avenue
Akron, CO 80720
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
be or attach it to this form along with your written report and map. Annual Report instructions are
e lose .
Signature o orporate Officer, Owner, or Designee
Date
M:IPERMITIMASTEP DOC UMENTS\M-AF-04