Laserfiche WebLink
Ac.S <br />ANNiiAi. FF.F, and RF.PnRT RF.niTF.ST <br />PERMITTEE NAME: ;/ Georgia Pacific R~~t=~' <br />PERMIT NO.: /M-1977-247 ~ MQR ~ ~ 2~~6 <br />OPANNIVERSARYDATE: April28, 006ry ~~roaurMmefu~sanoGAuloBY <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />i1~=~Lv I <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />--reciarnation accomplisiiz8 to-date-arrd`durirrg`the pret`e~ing-year-new disturbances thai are anTCcip`aFedTo occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />please attach ynnr revised written annual report and annnal report main to this form. Please note that att <br />adequately labeled map that clearly delineates acrd includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: ~ / <br />Permittee Contact: Bob Shajary ~W '1 +~~ t'~ tl ~ tl 6 / / 1 .~ `~ ti G -~t V f 't (~ I <br />Permittee Name: Georgia Pacific T& {Gt ~'~~ t,, J ~ c~v / 1 ti 9 ~ o 0 1 ~ ~ ~ <br />T <br />Address: 1401 Pier D Street ~ o C~,~ y ,~ Q C ~~ o w. <br />~QP r2_~o~"~ ~A r <br />Long Beach, CA 90802 <br />Phone Number: (562} 435-7711 <br />Fax Number: (562) 432-5096 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />_~~~ <br />Sign o Corporate Officer, Owner, or Designee <br />al~faa <br />Date <br />