2004-12-21_REPORT - M1978349

• Permit No: M1978349
• IBM Index Class Name: Report
• Doc Date: 12/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Dick Casey Concrete Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNiIAi, FF.F, and RF.P(lRT RF.t7iTFST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Dick Casey Concrete, Inc.
M-1978-349
Dick Casey Concr Pit
December 20, 2004
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7'~~'"
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...,,rr!s 8 Crrlerg
$688.00 (Due on or before your anniversary date)
Garfield
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,
_ _redamation. accomplished=fo date-and during the-preceding-year,-nerd'dlsturbarrees=tSat-are`al~i`ctpate~~to~oc`our `" - I
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 your revised written annual rennM and anneal re~nrt man to this form- 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: Shawn Vondette
Permittee Name: Dick Casey Concrete, Inc.
Address: P.O, Box 1815
Rifle, CO 81650
Phone Number: [phone]
Fax Number: [phone] __ _ _ . _ _
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to thi~'onn along with your written report and map. Annual Report instructions are enclosed.
Officer, Owner, or Designee
pkc. i5, aooy
Date