2006-09-07_REPORT - M2000110 - Laserfiche WebLink

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iV " R'I 8 ~ ~~ ~GD PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNPJERSARY DATE: ANNUAL FEE DUE: COUNTY: ~/ ANNUAL FEE and REPORT REQUEST /Mario Bassi and Josephine Bassi l/ M-2000-110 North Farm Road Gravel Pit September 17, 2006 /gpp 0 7 2006 ~f5ivision of Reclamation, Mining and Safety $688.00 (Due on or before your anniversary date) Rio Grande 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 chat?-submi?~-tha-a*ueual-fee;-a-repent-sn~!--ma-nb the-e;:tar:E-c£-ee-:~ec:t--r~isturbanees-to-off vted-land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to 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 upon revised written annual report and annual report man to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report. and associated map (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: Mario Bassi Permittee Name: Mario Bassi and Josephine Bassi Address: 2000 N. Farm Rd. Monte Vista, CO 81144 Phone Number: (719) 852-3225 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. Annual Report instructions are enclosed. Signatur~orp ~a O rcer, Owner, or Designee R ~( o~ Date