2006-06-22_REPORT - M2000032

• Permit No: M2000032
• IBM Index Class Name: Report
• Doc Date: 6/22/2006
• Doc Name: Annual Fee/Report/Map
• From: M.A. Concrete Construction Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~S
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
f/ ANNiIAi, FF.F, and RFPt7RT RF.niTFST
/ M.A. Concrete Construction, Inc.
/M-2000-032
Monument View Gravel Pit
July 14, 2006
Yom'
RECEIVED
~ JUN 2 2 2006
lj Division of Minerals end CeatoBY
$688.00 (Due on or before your anniversary date)
Mesa
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 Xpnr revised written anmral re~nrt and annual report m,~ to this form. The Annual Report
& Fee requirement is not met until we have received the following 3 components: fe,Q, r~pnrt, and associated
inDµ (A113 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
suffrce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Martin Azcarraga
Permittee Name: M.A. Concrete Construction, Inc.
Address: 2323 River Rd.
Grand7uriction, CO 81505 ~ -
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 this form along with your written report and map. Annual Report instructions are enclosed.
Date