2006-05-17_REPORT - M1978327

• Permit No: M1978327
• IBM Index Class Name: Report
• Doc Date: 5/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Jake Kauffman & Sons Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY;
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f/ ANNiJAT, FRF. and RF,P(lRT RF,t7iTF.RT
i/ Jake Kauffman & Son, Inc.
// M-1978-327
Kauffman Pit
May 14, 2006
RECEIVED
'MAY 1.7 2006
~/ BivisiotlefMiapahand
$688.00 (Due on or before your anniversary date)
Larimer
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,
rec amat~on aci;omp ~s ed to date and dunng 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 attagh ynnr revised written annnal rennrt and annnal rennrt maTtn this fnrm_ 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: Mary Kauffman
Permittee Name: Jake Kauffinan & Son, Inc.
Address: 808 SCR 9E
Loveland, CO 80537
Phone Number: _(970) 667-1557 _ __ _
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.
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Si atu of orp e Officer, bwn~Designee ~
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