REP30652

• Permit No: M1978283
• IBM Index Class Name: Report
• Doc Date: 5/1/2006
• Doc Name: Inadequate letter
• From: DMG
• To: Walsenburg Sand & Gravel Inc.
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Walsenburg Sand & Gravel, Inc.
M-1978-283
Sand Arroyo
Apri124, 2006
$688.00 (Due on or before your anniversary date)
Huerfano
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 showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding yeaz, new disturbances that aze 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 yeaz, if any.
Please attach your revised written annual reuort and annual report man 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:
Permittee Contact: Louis Vezzani
Permittee Name: Walsenburg Sand & Gravel, Inc.
Address: Hwy. 10
Walsenburg, CO 81089
Phone Number: [phone]
Fax Number: [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.
Signature of Corporate Officer or Owner
Date