2005-12-20_REPORT - M1978349

• Permit No: M1978349
• IBM Index Class Name: Report
• Doc Date: 12/20/2005
• Doc Name: Annual Fee/Report/Map
• From: Dick Casey Concrete Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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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, 2005
$688.00 (Due on or before your anniversary date)
Garfield
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_ According to C.R.S.3932.5-116_ or C :R.S. 34-32-116, each year, on the armiversa_ry date of the permit 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 Xnnr revised written annnal report and annnal re~nrt ma= 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: Shawn Vondette
Permittee Name: Dick Casey Concrete, Inc.
Address: P.O. Box 1815
Rifle, CO 81650
Phone Number: [phone]
Fax Number: [phone]
D~nsi- Aoo 9~o/ba.~- o~y6
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to th~}s form along with your written report and map. Annual Report instructions are enclosed.
of Corporate Officer, Owrier, or Designee
I~FiC,~~OQ~
Date