2007-07-25_REPORT - M1974086

• Permit No: M1974086
• IBM Index Class Name: Report
• Doc Date: 7/25/2007
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Paving Company
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEL1and REPORT REQUEST
PERMITTEE NAME: Asphalt Paving Company
PERMIT NO.: ~M-1974-086
OPERATION NAME: Ralston Quarry
ANNNERSARY DATE: July 24, 200~i7
ANNUAL FEE DUE: $$559:00 ~~~i r before y ur anniversary date)
COUNTY: Jefferson
A~

' JUL 2 a 2001
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Division of ttecraD~stron,
Mining and Safety
-' --- According to C.R:S-34=32:5=YP6'or'C:R:S-34=32=116, each year; on the anniversary" date of tfie 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 map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred durinti the previous year and no
new chanties to the previous year's map 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:
Permittee Contact: Greg Geryanoff
Permittee Name: Asphalt Paving Company
Address: 14802 W. 44th Ave.
Golden, CO 80403
Phone Number:
Fax Number:
[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 o orporate Officer, Owner, Designee
Date
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M:IPERMI74NASTERD000MENTS/M-AF-02.DOC