2006-04-17_REPORT - M1978283

• Permit No: M1978283
• IBM Index Class Name: Report
• Doc Date: 4/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Walsenburg Sand and Gravel Co Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMTI'TEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
f/ANNiiAI, FFF, and REPORT RF.lli1F.ST
/Walsenburg Sand & Gravel, Inc.
M-1978-283
Sand Arroyo
April 24, 2006
FiECEiVE~
~' APR 17 2006
~irision of Mieernls and Geelosy
$688.00 (Due on or before your anniversary date)
Huerfano

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 coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ym~r revised written anneal tgpnrt and anneal report m„gp to this form. Please 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: Louis Vezzani
Permittee Name: Walsenburg Sand & Gravel, Inc.
Address: Hwy. 10
Walsenburg, CO 81089
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, O or Designee

Date