2006-01-02_REPORT - M1987049 - Laserfiche WebLink

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ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Ready Mixed Concrete Company M-198'7-049 Bromley Lakes September 29, 2006 OCT ~ 2100 t)IVi510A pf Reclamation, Mirioy snd gafaty $688.00 (Due on or before your anniversary date) Adams 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 yeaz, 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 yeaz, if any. Please attach your revised written annual report and annual report map to this form. The Anuual 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 suffcefor a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: tt~~f/~ Permittee Name: Ready Mixed Concrete Company Address: CF.PR.address 1 14585 Old Brighton Rd. $righton, CO 80641 Phone Number: (303} 659-0630 Fax Number: A/Q ~n ~l(,~Ka++ 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 aze enclosed. r~ f~ ~~~~~ ' Signature o~ fCorporate Officer, Owner, or Designee ~= ~oG Date