2007-06-01_REPORT - M1986016 - Laserfiche WebLink

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~_~P~I ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Caldwell Brothers (/M-1986-016 Caldwell Brothers 3 June 1, 2007 RCCEli/ED vJUN 012007 Di sion of Reclamation, Mining and Safety $$688.00 (Due on or before your anniversary date) Otero 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 ~- _S11a1Lsubmit the annual fee, a report and map showing the extent of current disturbances to affected land, ' reclamation accomplished to date and during the preceding yeai, new disturbances-that~rranticrpated-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 vour revised written annual resort and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated maa. If no new disturbances or reclamation have occurred durinti the previous year and no new chanties to the urevious year's man are necessary. then no new maa is required, provided that the Oaerator shall state this in the Annual Renort. Please note that an adequately labeled map that clearly delineates and includes the above elements may su~ee for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Wayne Caldwell Permittee Name: Address: Phone Number: Fax Number: Caldwell Brothers 25026 Rd. 19 Rocky Ford, CO 81067 (719)254-3210 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 aze enclosed. Signa re of Corporate Oflicer, Owner, or Designee Date