2007-09-17_REPORT - M1976018 - Laserfiche WebLink

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~~~~~ ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: North Weld Gravel ~ PERMIT NO.: ~ M-1976-018 OPERATION NAME: North Weld Gravel ANNIVERSARY DATE: October 17, 2007 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Weld RECEIVED SEP 172007 Dwtslon of ReGamation, Mining and Safety 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 your 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 during the previous year and no new chances to the previous year's map are necessary, then no new maq 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 sufftce for a written report. Division records in rcate the following permittee contact information. Please verifyyd make any necessary changes: /vU ,f ~C~u-e 9~-Lccr/` ~,.-~Luz t'o/'oze '~ G2-~-~Q ~-~ ~ loo ~ , ~~ ~ ~ s~ ~- ~~ y~ ~>~ ~:~.e_ Permittee Contact: Leroy A. Bellmore Pennittee Name: Address: North Weld Gravel 13480 WCR 100 Nunn, CO 80648-9700 Phone Number: (970) 897-2252 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. Signature o CQor~porate/Officer, Owner, or Designee ,5~~z~~~~^, /O o2 Do ') Date