2001-10-03_REPORT - M1980135

• Permit No: M1980135
• IBM Index Class Name: Report
• Doc Date: 10/3/2001
• Doc Name: Annual Fee/Report/Map
• Media Type: D
• Archive: No

Ill 11lIIIIIIlIII
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: Western Cleanup Corporation RECEIVED
PERMIT NO.: M-1980-135
OCT o 3 zoos
OPERATION NAME: Headley Farms
ANNIVERSARY DATE: October 7,2001 Division of Minerals and Geology
ANNUAL FEE DUE: $689.00(Due on or before your anniversary date)
COUNTY: Morgan
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 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 may to this form. Please note that at
adequately labeled reap that clearly delineates and includes the above elements may safce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ron Greene I(��e-,/
Permittee Name: Western Cleanup Corporation
Address: 1320 E. Burlington Ave.
�e CO 80701 TT O� .1L 8070�
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or att form along with your written report and map. Annual Report instructions are enclosed.
v
Signature of Corporate O icer or Owner
Date
FI.TER M INIASTERDOCU M ENTSNI-AF-01