Laserfiche WebLink
III IIIIIIIIIIIIIIII <br /> 999 RECEI9,n�r q� <br /> ANNUAL FEE and REPORT REQUEST OCT 2 6 VIM <br /> PERMITTEE NAME: Goose Haven Sand & Gravel, Inc. <br /> Division of Minerals and Geology <br /> PERMIT NO.: M-1984-099 <br /> OPERATION NAME: Bailey Pit <br /> ANNIVERSARY DATE: September 29,2001 <br /> ANNUAL FEE DUE: $698.00(Due on or before your anniversary date) <br /> COUNTY: Weld <br /> 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 <br /> shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br /> during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br /> of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Doug Tiefel <br /> Permit(ee Name: Goose Haven Sand &Gravel, Inc. <br /> Address: P.O. Box 17130 <br /> Boulder, CO 80308 <br /> Phone Number: (303) 665-9390 <br /> Fax Number: { -'2) — (o (p <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br /> Signature of Corporate Officer or Owner <br /> � 121e1 <br /> Date <br /> M'TERM I'DMASTERDOCUMENTS\M AF-01 <br />