REP32789

• Permit No: M1976059
• IBM Index Class Name: Report
• Doc Date: 6/19/2000
• Doc Name: ANNUAL REPORT
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

• I.
ANNUAL REPORT
INSTRUCTIONS
According to C.R.S. 34-32-116(3). and C.R.S. 34-325-1 I6(3)(a), on the anniversary date of the permit each year,
[he operator shall subnut a report and a map showing the extent of current disturbances [u affectzd land,
reclamation accomplished to date and during the preceding year, new dismrban~es that arc anticipated to occur
during the upcoming year, and reclamation that will he perfornted during the upcoming year. Please attach such
a report and map to enclosed annual report form. (An adequately labeled map [hat clearly delineates and includes
the above elements may suffice for a written report.)
If your operation is subject to the provisions of Temporary Cessation as defined in the Ac[ and Rules. you must
provide with the Annual Reporl the following information as required by 2 CCR 407-1, 407-4, and Rules
1.13.7(1)(x):
(I) the condition of the operation at the time of cessation;
( ii) what specific measures have been and will be implemented to co nply with reclamation,
performance standards and Environmental Protection Plan requirement;, if they are part of your
approved application; and
( iii) plans for resumption of nursing operations.
Please provide the additional following iNbrnta[ion with your Annual Report. s applicable:
(a) Per [he requirements of ?CCR 4117-1.407-4, and Rules 1.15(1),provide anupdated statement
regarding the sufficiency of the value of the Financial Warranty, specifically:
(i) Per the requirements of 2 CCR 407-1, 4(17-4, and Rules 1.15(1)(x), provide an updated
statement regarding the sufficiency of [he value of the financial warranty. Specifically,
irrevocable letters of credit Deeds of Trust, and security agreements, self-insurance, salvaee
credit, and first priority lizns on project related fixmres.
( ii j Per the requirements of Z CCR 407-1, 407-4, and Rules 1.15(1)(b), pernuts secured with a
Deed of Trust or a Security Agreement the operator shall subnut an update, by a qualified
independent appraiser, indicating any changes in property value, and a statement summarizing
am circumstances which may affect the adequacy of [hc Deed ~f Trust, or Securiq~ Agreement.
and [he value of the property subject tp either of these instruments.
The report shall also provide proof that there are no past-due property taxes.
(iii) Per the requirements of 2 CCR 407-1, 41)7-4, and Rules ~t.7(3), permits secured with an
Irrevocable Letter of Credit, the operator shall have the baM provide documentation in the form
of a balance sheet certified by a Certified Public Accountant, demonstrating that the Letter of
Credit does not exceed ten percent (] 0~7~) of the baN:'s capita] surplus accounts.
( vi) Per the requirements of 2 CCR 407-1.407-4, and Rules a.9.3(c), pernuts secured by a First
Priority Lien on any t7xmres and Equipment, the operator shall provide a report in sufficient
detail to fully describe [he condition, value, and location of all pledged fixtures and equipment.
(h) Per the requirement. of ?CCR 407-1, 407-4, and roles 1.15(1)(c). all mo iinving inlormatirm required as part
of the approved perntit application. to include the Environmental Protection Pl.m. (Please note that if you are not a
Desienated Diining Operation, you null not have an Environmental Protection flan as part of your approved permit.)