2006-08-10_REPORT - M1982129 - Laserfiche WebLink

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RECEIVED ~~ / Al1G i 0 2006 vDivision of ReGamation, M' PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ~ ANNUAL FEE and REPORT REQUEST mm9 and Safety / L. Otto Goemmer M-1982-129 Rocky Flat Gravel August 5, 2006 $281.00 (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 vour revised written annual report and annual report man to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map (All are required regardless of the level of disturbance or absence of disturbance during the previous year). Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Jacque Goemmer Permittee Name: L. Otto Goemmer Address: P.O. Box 165 La Veta, CO 81055 Phone Number: (719) 742-3561 Fax Number: 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. ign re of Corporate Officer, Owner, or Designee ab'- a~-- a Date ~-~ -D~ ~-rv~