2001-12-14_REPORT - M1978349

• Permit No: M1978349
• IBM Index Class Name: Report
• Doc Date: 12/14/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Dick Casey Concrete, [nc.
M-1978-349
Dick Casey Concr Pit
December 20, 2001
RECEIVED
DEC 1 4 2001
Division of Minerals and Gealagy
$688.00 (Due on or before your anniversary date)
Garfield
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during [he upcoming year, reclamation that will be performed during [he coming year, the dates For the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual resort map to this form. Please note that an
adequately labeled reap dtat clenrly delineates anti includes the above elements tnay sake far u written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Shawn Vondette
Permittee Name: Dick Casey Concrete, Inc.
Address: P.O. Box 1815
Rifle, CO 8]650
Phone Number: (4~(I-}~45-379 7o ba ~- ~yd
_. Fax Number:- ~Sd3 - - __ _ _ 71/ bas - i~ 6
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
ignature of Corporate Officer or Owner
Q~c. /0 . ~oo~
Date
M ~PERM11frN1A5TERD000MENT$N1-AF-01