2003-12-08_REPORT - M1978349

• Permit No: M1978349
• IBM Index Class Name: Report
• Doc Date: 12/8/2003
• Doc Name: Annual Fee/Report Notice
• From: Dick Casey Concrete Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dick Casey Concrete, Inc.
M-1978-349
Dick Casey Concr Pit
December 20, 2003
RE~gIVE®
DEC 0 8 2003
Divisic.. - _ _ _..._yY
$688.00 (Due on or before your anniversary date)
Garfield
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the
shaiLsubm:t-th.,-Qnnual-fee,-a-report-and-mag-shawitrg-the ex ent o current isturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annual re~nrt and annnal report mat to this form. pease note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Shawn Vondette
Permittee Name: Dick Casey Concrete, Inc.
Address: P. O. Box 1815
Rifle, CO 81650
Phone Number:
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this rm al ng with your written report and map. Annual Report instructions are enclosed.
Signature of Corporafe Officer, Owner, or Designee
/~2~
Date
M iPHRM ITU1 ASTERDOCOMENT$U-0-AF-01
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