2007-09-10_REPORT - M2000089 - Laserfiche WebLink

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ANNUAL FEE and REPORT REQUEST ' ' ~ . ', ..i -,_ PERMITTEE NAME: Ignacio Vasquez Sr ~ ` - -~~7 PERMIT NO.: -2000-089 Division u...~azmztion, _, _ l:inin~ snd fi~`~:y OPERATION NAME: Perdue ANNNERSARY DATE: October 4, 2007 ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) COUNTY: Boulder iCccording-fo C.R:S: 34=32:5=1-t6-or G.R.-S~4-32-1-16,-each-yearTn theanniv5rsary 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. If no new disturbances or reclamation have occurred during the previous year and no new chances to the previous year's moo are necessary, then no new moo is required, nrovided that the Operator shall state this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the above elements may suli"ice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Ignacio Vasquez Sr Permittee Name; Address: Phone Number: Fax Number: Ignacio Vasquez Sr P.O. Box 938 Lyons, CO 80540 (303)823-5684 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. Amual Report instructions are enclosed. Sign ure o Corporate icer, ner, or Designee Da