2006-09-20_REPORT - M1977075 - Laserfiche WebLink

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z ,.; ? ~~ ~ q~-d ~~ ~ PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ANNUAL FEE and REPORT REQUEST `~ Holyoke Gun Club t/M-1977-075 Holyoke Gun Club Pit September 27, 2006 SEP 2 0 2006 @ivi~ian of Reclamation, Mining ono Safety $281.00 (Due on or before your anniversary date) Phillips According to C.R.S. 34-32.5-1 16 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 year, new disturbances that-are anticipated-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 year, if any. Please attach your revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated man (All are required regardless of the level of disturbance or absence of disturbance during the previous year). Please note that an adequately labeled map that clearly delineates and incdudes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Gary Hershfeldt Permittee Name: Address: Holyoke Gun Club 20358 CR 45 Holyoke, CO 80734-9507 Phone Number: (970) 854-3641 Fax Number: 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. ll~~, D~. ,~,,.__ Signature of Corporate Officer, Owner, or Designee Date