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CLEAN WATER PERMIT ANNUAL FEE INVOICE <br />Water Quality Control Division <br />www.00loradm atemermits.com <br />CDPHE <br />4300 Cherry Creek Drive <br />Mail Code ASD -AR -B1 <br />Denver, Colorado 80246 -1530 <br />Riverside Aggregates LLC <br />Rudy Torres <br />1750 CR HH <br />Lamar, CO 81052 <br />Colorado Department <br />of Ibl1CHealth <br />and Environment <br />Date: <br />7/2312014 <br />Customer #: <br />WQ004311 <br />Permit #: <br />COR341590 <br />invoice #: <br />SW1003792 <br />Annual billing for Permit COR341590 - Friedrichs Pit, CR LL and Hwy 287, Wiley, CO 81092 for the Period of 7/1/14- <br />6/30115 <br />Amount: $ 75.00 <br />Payments or Credits: $ 0.00 <br />Balance Due: $ 75.00 <br />Payment Due Date: 8122/2014 <br />See reverse side of this invoice for more information. <br />I PAYMENT DUE WITHIN 30 DAYS 1 <br />- - - --- - -, - - - PL. EASETEARALCNG- PMORATM- ANORETURN- BOTTOMPORTIONOFWVOi - WffHPAYMENT -- - -- - <br />Riverside Aggregates LLC <br />Rudy Torres <br />1750 CR HH <br />Lamar, CO 81052 <br />BILLNG INQUIRIES: <br />3034692 -3616 <br />CHANGE OF ADDRESS: <br />If your billing address is incorrect, please submit a orange of address on the <br />appropriate form available at www.opbmdovatenmmks.com <br />Call 303- 692 -3517 for assists with submitting a change of address. <br />MAKE CHECKS PAYABLE TO CDPHE <br />REMIT PAYMENTS TO: <br />CDPHE <br />4300 Cherry Creek Drive South <br />WA Code ASD -AR -B1 <br />Denver, Colorado 80246 -1530 <br />Customer#: VY0004311 <br />Invoice #: SW1003792 <br />Balance Dine: $ 75.00 <br />CREDIT CARD PAYMENT - Complete the information below or <br />call 303-M -2130 <br />Name on cad: <br />VisalMC M <br />Security Code(3 digit code located on back of card): <br />Expires: / Phone#: ( ) To receive a receipt provide your Fax # or Email address: <br />Fax #: ( ) - <br />Email address: <br />