2007-08-18_REPORT - M1983164 - Laserfiche WebLink

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~~ ~ ~ Y ~ 6 ANnfUAL FE)` and REPORT REQUEST PERMITTEE NAME: r George F. Gallegos R~(A',cp~ ~~~ PERMIT NO.: (iNI-1983-164 ~ ~~ 1 ~ 1007 DIVI;,,u~ OPERATION NAME: Gallegos Pit +n+n U~ ^tc'd'T~ohon, (~ 9 and Sa¢eti ANNIVERSARY DATE: August 25, 2007 ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) COUNTY: Conejos 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, ceclamatian-accomplished-to date and-during-the preceding-year,-new-distarbartces-that-are anticipated-to ocear- 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 map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee. report, and associated maD. If no new disturbances or reclamation have occurred during the previous year and no new chances to the previous year's map are necessary, then no new map is repaired, provided that the Operator shall state this in the Annual Report. 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: George F. Gallegos Permittee Name: Address: George F. Gallegos P.O. Box 575 Romeo, CO 81148 Phone Number: (719) 843-5113 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. or Designee (l ~l~ U Date