2005-11-21_REPORT - M1977053

• Permit No: M1977053
• IBM Index Class Name: Report
• Doc Date: 11/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Constructors Inc.
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
/Asphalt Constructors, Inc.
~j1~~I-1977-053
Lyle Smith Pit
December 23, 2005
~hP ~
RECEIVED
~WOV 2 125
Division of Minerals and GeoloBY
$688.00 (Due on or before your anniversary date)
Costilla
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_tkte_annual~ee~a_report_andsttap..~hox+ing_the extent of _surren~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 ynnr revised written anneal re~nrf and anneal re on rt ma~tn Chic form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Todd A. Stockebrand
Permittee Name: Asphalt Constructors, Inc.
Address: 7040 Hwy. 160 W.
Phone Number:
Fax Number:
Alamosa, CO 81101
[phone]
[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.
Signature of orporate Officer
_~~~
Date