2008-01-02_REPORT - M2000092 - Laserfiche WebLink

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ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: 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 during the preceding year, new disturbances that aze anticipated to occur during the upcoming yeaz, 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 renort and annual renort mao to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, renort, and associated maa. If no new disturbances or reclamation have occurred during the previous vear and no new chanties to the previous year's mao are necessary. then no new man 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 suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: City of Walsenburg M-2000-092 Walsenburg Gravel Pit December 14, 2007 $$323.00 (Due on or before your anniversary date) Huerfano Permittee Contact: Eric Pearson Permittee Name: City of Walsenburg Address: 525 S Albert Walsenburg, CO 81089 Phone Number: (719) 738-1240 Fax Number: (719) 738-1875 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 or Owner Date