2007-08-15_REPORT - M2005061

• Permit No: M2005061
• IBM Index Class Name: Report
• Doc Date: 8/15/2007
• Doc Name: Annual Fee/Report/Map
• From: M.A. Concrete Construction, Inc.
• To: DRMS
• Media Type: D
• Archive: No

~~
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE llUE:
COUNTY:
M.A. Concrete Construction, Inc.
~M-2005-061
20 Road Gravel Pit
September 1, 2007
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~ AUG ~ ~ 2007
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1)~IOn w nclaal u~u..n,
Mining and Safefy
$$791.00 (Due on or before your anniversary date)
Mesa
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 year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be perfornred during the coming year, the dates fur 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
map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to
the previous year's map are necessary, then no new map is required, 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 suffice 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 Road
Grand Junction, CO 81505
Phone Number:
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.
Signature of Corporate Officer, Owner, or Designee
Date