2007-07-27_REPORT - M1989024 - Laserfiche WebLink

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low PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ~ ~ - ~- 07 ~; ~~°~ AIVNIIAL FEE and REPORT REQUEST ~ Edward M. Yaklich ,~v ~M-1989-024 ~~~^*~~~~~® Shangri La Pit ~/ ~~U( 2 71D07 Jul 007 ~~ l , .3l ' ~ / ~/y~ Dry~sion of Reclamatio e on or before your anniversary-date) M~rong and Safety n' Custer 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 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 reuort and annual reuort maa to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, reuort, and associated ma If no new disturbances or reclamation have occurred during the previous year and no new chances to the previous year's man are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. 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: Pennittee Contact: ward W. aklich i Permittee Name:- award . Ya Bch Address: 1180 CR I29 Westcliffe, CO 81252 Phone Number: (719) 783-4700 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. Signature of Corporate Officer, Owner, or Designee Date RECEIVED JUL 7 201