2006-08-21_REPORT - M1983164 - Laserfiche WebLink

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,~~2 ~-~'- ~,~~ PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: /ANNUAL FEE and REPORT REQUEST t/ George F. Gallegos r/M-1983-164 Gallegos Pit August 25, 2006 RECEIVED ~~auc z ~ zoos Division of Reclamation, Mining and Safety $281.00 (Due on or before your anniversary date) Conejos 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_accompliahed to date and during the.preceding_~, new disturbances that are anticipated t_o 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 year, if any. Please attach vour 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 maa (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 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: George F. Gallegos Petmittee Name: George F. Gallegos Address: P.O. Box 575 Romeo, CO 81148 Phone Number: 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. Annua] Report instructions are enclosed. ' ature Corporate Office Owner, or Designee /s~~o ~ Dat (719) 843-5113