2007-09-18_REPORT - M1998059 - Laserfiche WebLink

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ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: L & L Ready Mix M-1998-059 Sunny Dale Farm Pit September I5, 2007 $$791.00 (Due on or before your anniversary date) Phillips According to C.R.S. 34-32.5-116 or C.R.S. 3432-116, 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 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 anneal 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 Infl~,. If no new disturbances or reclamation have occurred dnrin¢ the previons year and no new ehapaes to the previous year's map are neeessarv. then no new map is respired. provided that the Operator shall state this in the Annnal Report Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice jor a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Laurine Kcellner Permittee Name: L & L Ready Mix Address: P.O. Box 2 ] 8 Haxtun, CO 80731 Phone Number: (970) 774-6114 Fax Number: (970) 774-6114 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. Signatu er of Corporate Officer, Owner, or Designee ~~/.5~ Date