Laserfiche WebLink
V~1' 11, I~F.F. and RF I'(1R 1' RFlll 1'ti l' <br />I'lilt\9flTfl NAMI.: <br />ANN!+A1. Fhli UI'I•: <br />t.'t)UN I1': <br />1'amrock (:race! <br />~1-2(1111-1168 <br />RulWmlcss Nit <br />Septend+cr 17, 20t)6 <br />Sn88.1111 (Uuc un or before your anniversary date) <br />I.as :\nintas <br />According a, ('.R ti, id-t2,5-I 16 ar ('.R.ti. ?-1-32-I 16, each year, on the anniversan date ol'the permit. an operator <br />.boll submit the anmmi I'ce n tenor( anti man shotvmg the v,(k•nr r,l snrrent dianrh:mci ~ rn ;dTrcrrd fond. <br />rrclantauon at:cumpltshcd w date and durntg the preceding year. new dtsturhancr> that arc antacip:ucd to occur <br />dunng thr upn+mmg year. reclantaliun that will be pcrtiu'nted during the connrtg yrur. the date for the hegu+nut~ ul <br />JCIIt'C UnCfJnarls. Jntl IIIC ll:rlt.• :Il'l1Yl' upcraUons ceased li+r thr year. tl'am•. <br />Please attach your revised written annual moor( and anuurl reuorl atop A, this farm l he :\nnu:d Report S <br />Pee requirement i. not nu•1 until we have rccciscd the Rdlowiny; components: fee, moor(, and associated mau <br />VI arc required rcyturdlcss of the Icvcl of diswrbunce or absence of disturbance durint; the pmvious year). <br />1'!. <r,r ,rn; ~' Ilrut cur udeyuutt'/v /tdrrle'd unr/r dew rJrurJt' t/vlirtcutr'c curt! rnt•ludrs the a/rove' r/enu•nh' nrut ..u%lin' Ihr <br />.r xri(frn rt'prrrt .. .. <br />I)ivisurn record. indicate the litllawtng permitter contact inlimnutiun. Plrtsc tcnly and make any necessary <br />change.: <br />I'rnnutrc<'ontacl: l3rcnt'Iamhurclli <br />I'cmunct: \amc: inmrork (irJCCI <br />rWdress: 137 Plum <br />frtntdud, (l) R I III ~ <br />I'ht,nr Nuntbcr: 1?I')) 8J6-Niad <br />I'as Number' I?Iq) 2+db-"tiq' <br />IY you hove addiunnal rununrnts und'or inti,rtrtatiun thm should be pruvidrd to thr I)iwsian, plea>c pruvklc it below <br />or ;utach a h, this ti>rnt along wuh your wrtticn report :uui map. Annual Report mstrucuans arc carload. <br />_ y_r ~ ~ ;"'-T"- ~. 1 ~~~ _uI-l • ~ -l• ~ • /{.Hd:ilC ~ _y~~ Zi- 1 ~-_- 'ir fw(e'... ~~.a(fe ~t <br />`' «< <br />tiymaturc o 'urporatr Otliccr, Uwncr. or Ucsignee <br />1)alc <br />