2001-11-19_REPORT - M1977053

• Permit No: M1977053
• IBM Index Class Name: Report
• Doc Date: 11/19/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII
999
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Asphalt Constructors, Inc.
M-1977-053
Lyle Smith Pit
December 23, 2001
$688.00 (Due on or before your anniversary date)
Costilla

RECEIVED
NOV 19 2001
Division of Minerals and Geelo9Y
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 dote 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 report map to this form. Please note that ott
adegtmtely labeled map that clenrh~ delineates and includes the above elements may sn~ce for a written report.
Division records indicate the following permi[[ee contact information. Please verify and make any necessary
changes:
Permittee Contact
Permittee Name:
Address
Todd A.Stockebrand
Asphalt Constmctors, Inc.
P.O. Box 449
Alamosa, CO 81 101
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or infornation 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 or Owner
//~/3/oi
Date
M.~PERM mMASTERDOCUMENTSVd-AF-01