2002-12-18_REPORT - M1978349

• Permit No: M1978349
• IBM Index Class Name: Report
• Doc Date: 12/18/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Dick Casey Concrete, Inc.
M-1978-349
Dick Casey Concr Pit
December 20, 2002
RECEIVED
DEC 18 2U02
Oiaision of Minerals and Geolosy
$688.00 (Due on or before your anniversary date)
Garfield
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,
reclamation accomplished to date and unng t e prece mg year, new rs ur ances a are r ~
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. 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:
Permitiee Contact: Shawn Vondette
Permittee Name: Dick Casey Concrete, Inc.
Address: P.O. Box 1815
Phone Number:
_ .Fax Number:
Rifle, CO 81650
[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 thj~ form along with your written report and map. Annual Report instructions are enclosed.
of Cot~'orate Officer, Owner, or Designee
0~ ~.
Date
aooa
M:IPERM ITNIASTERDOCUMENTSU1-AF-OI