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CLEAN WATER PERMIT ANNUAL FEE INVOICE <br /> OF-Col <br /> Water Quality Control Division <br /> www.coloradowateri)ermits.com �q <br /> CDPHE * * <br /> 4300 Cherry Creek Drive 1876 <br /> Mail Code ASD-AR-131 <br /> Denver, Colorado 80246-1530 Colorado Department <br /> of Public Health <br /> and Environment <br /> Riverside Aggregates LLC Date: 7/23/2014 <br /> Rudy Torres Customer#: WQ004311 <br /> 1750 CR HH Permit#: COR341590 <br /> Lamar, CO 81052 Invoice#: SW1003792 <br /> Annual billing for Permit COR341590- Friedrichs Pit, CR ILL and Hwy 287, Wiley, CO 81092 for the Period of 7/1/14- <br /> 6/30/15 <br /> Amount: $ 75.00 <br /> Payments or Credits: $ 0.00 <br /> Balance Due: $ 75.00 <br /> Payment Due Date: 8/22/2014 <br /> See reverse side of this invoice for more information. <br /> PAYMENT DUE WITHIN 30 DAYS <br /> PLEASE TEAR ALONG PERFORATION AND RETURN BOTTOM PORTION OF INVOICE WITH PAYMENT <br /> Riverside Aggregates LLC Customer#: W0004311 <br /> Rudy Torres Invoice#: SW1003792 <br /> 1750 CR HH Balance Due: $ 75.00 <br /> Lamar, CO 81052 CREDIT CARD PAYMENT—Complete the information below or <br /> BILLING INQUIRIES: call 303-692-2130 303-692-3616 Name on card: <br /> CHANGE OF ADDRESS: Visa/MC#: <br /> If your billing address is incorrect,please submit a change of address on the <br /> appropriate form available at www.00loradowateroermits.com Security Code(3 digit code located on back of card): <br /> Call 303-692-3517 for assistance with submitting a change of address. <br /> Expires: / Phone#:( ) - <br /> MAKE CHECKS PAYABLE TO CDPHE <br /> To receive a receipt provide your Fax#or Email address: <br /> REMIT PAYMENTS TO: <br /> CDPHE Fax#:( ) - <br /> 4300 Cherry Creek Drive South <br /> Mail Code ASD-AR-B1 Email address: <br /> Denver,Colorado 80246-1530 <br /> 6.V161W <br />