Laserfiche WebLink
~~P~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/'Nielsons, Inc. <br />~4=1976-059 <br />Cortez Pit <br />Juue 17, 2007 <br /> <br />7.i %~t~~ <br />Ot <br />~„ <br />$$688.00 (Due on or before your anniversary date) <br />Montezuma <br />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 <br />-shall- submit the-annual.-fee;_a-reporx-and-map showing the~xtent of_current disturbances_to_affected ~and,- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous veer and no new chances to <br />the previous year's maa are necessary, then no new man is required, arovided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Craig Wickstrom <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Nielsons, Inc. <br />22419 CR G <br />P.O. Box 1660 <br />Cortez, CO 81321 <br />(970)565-8461 <br />(970)565-0188 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~' G!~~ sl~~o7 <br />Signatu of Corporate OfScer, Owner, or Designee <br />s~~//C>~ <br />Date <br />