2006-05-18_REPORT - M1978283

• Permit No: M1978283
• IBM Index Class Name: Report
• Doc Date: 5/18/2006
• Doc Name: Annual Fee/Report/Map
• From: Walsenburg Sand and Gravel Co Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Walsenburg Sand & Gravel, Inc.
M-1978-283
Sand Arroyo
Apri124, 2006
~~~~1~ED
/ / MAY t 8 20~
,/ Divleion of Minerals anA Geology
$688.00 (Due on or before your anniversary date)
Huerfano
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 the annual fee, a report and map showing the extent of current"disturbances to affected
-land;`reclamafiori accorriplishe3~to date and during the preceding year, new disturbances that aze anticipated to I
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 report and annual report map to this form. 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: Louis Vezzani
Permittee Name: Walsenburg Sand & Gravel, Inc.
Address: Hwy. 10
Walsenburg, CO 81089
Phone Number: [phone]
-" Fa"x Number: [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.
~?~~-wGuC~,v ~, awe
Signature of Corporate Of/ficer or er
~- ~~~
Date