2007-09-17_REPORT - M1998059

• Permit No: M1998059
• IBM Index Class Name: Report
• Doc Date: 9/17/2007
• Doc Name: Annual Fee/Report/Map
• From: L & L Ready Mix
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and RE~P{LO~RT REQUEST
L & L Ready Mix /
M-1998-059 V
Sunny Dale Farm Pit
September 15, 2007
RECEIVED
SEP 17 2UU7
Division of ReGamation,
Mining and Safety
$$791.00 (Due on or before your anniversary date)
Phillips
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 comigg 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, report, and associated
map. If no new disturbantes or reclamation have oaurred durinti the previous veer and no new chanties to
the previous year's map are neeessarv, then no new map is regnired, provided that the Operator shall state
this in the Anneal Report Please note that an adequately labeled map that clearly delineates and includes the
above elements may su~cefor a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Laurine Koellner
Permittee Name:
Address:
L & L Ready Mix
P.O. Box 218
Haxtun, CO 80731
Phone Number: [phone]
Fax 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, Owner, or Designee
9%/5~
Date