2004-09-16_REPORT - M1998059

• Permit No: M1998059
• IBM Index Class Name: Report
• Doc Date: 9/16/2004
• Doc Name: Annual Fee/Report/Map
• From: L & L Ready Mix
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMff NO.:
OPERATION NAME:
ANNPJERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
L & L Ready Mix
M-1998-059
Sunny Dale Farm Pit
September 15, 2004
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SEP 16: ~
Olv1a10° °t Minerals and Geo)a9y
$688.00 (Due on or before your anniversary date)
Phillips
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 -annual fee, a -report-and map"shaNing the exterit`of current disturbances to affected land,
-reclamation accomplished_to_date_and;during_[he_preceding_year, new_disturbances that are_anticipated to occur __
during the upcoming yeaz, 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 ynnr revised written annual rennrt and anm.al report m ~n to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Pertnittee Contact: Laurine Koellner
Permittee Name: L & L Ready Mix
Address: P.O. Box 218
Phone Number:
Fax Number:
Haxtun, CO 80731
[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.
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Signature of Corporate Officer, Owner, or Designee
_/yv
Date