2004-08-24_REPORT - M1974086

• Permit No: M1974086
• IBM Index Class Name: Report
• Doc Date: 8/24/2004
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Paving Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

S
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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Asphalt Paving Company
M-2974-086
Ralston Quarry
July 24, 200'-/
pUG 2 4 2004
Division of Mino~als & ~eolo9Y
$688.00 (Due on or before your anniversary date)
Jefferson
According to C.R.S. 34-32.5-116 or C.RS. 34-32-116, each yeaz, 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 year, new disturbances that aze anticipate3 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 yeaz, if any.
Please attach your revised written anmeal report and annnal report map to this form. please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following pemuttee contact information. Please verify and make any necessary
changes:
Permittee Contact: Greg Geryanoff
Permittee Name: Asphalt Paving Company
Address: 14802 VV. 44th Ave.
Golden, CO 80403
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 ~r l;orRporate Officer, Owiaer, or Designee
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Date
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