2007-03-08_REPORT - M1998034

• Permit No: M1998034
• IBM Index Class Name: Report
• Doc Date: 3/8/2007
• Doc Name: Annual Fee/Report/Map
• From: Mountain Park Concrete, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
//~ f~' f
" P'
ANNUAL FEE an ~ PORT REQUEST
/Mountain Park Concrete, Inc.
~M-1998-034
Parshal Pit
March 17, 2007
~~~
D~~is~o ~r ~~ ' a
`M'%g°a dsafeOOn
$$281.00 (Due on or before your anniversary date)
Grand
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_anntaal-fee, rTnort__and~n~p_showing_the,ext~nt_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 vour revised written annual report and annual resort map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
maa. If no new disturbances or reclamation have occurred during the previous vear and no new changes to
the previous year's mau 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 Conta
Permittee Name
Address:
Phone Number:
Fax Number:
Granby, CO 80446
[phone]
[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
P.O. Box 856