2008-07-29_REPORT - M1978208

• Permit No: M1978208
• IBM Index Class Name: REPORT
• Doc Date: 7/29/2008
• Doc Name: Annual Report
• From: Elk Creek Sand & Gravel LLC
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: ACS
• Media Type: D
• Archive: No

AL-Z5-2008 01:0TPM

PROM-DIV RECLAMATION MINING & SAFETY
PERMX TEE NAME:
PERMIT NO.:
[phone]

T-130 P.00VOR ""t
7?
ANNUAL FEE and REPOR.T REQUEST
1511k Creek Saud & Gravel, LLC
1V1-1978- L 218 zoos
OPERATION NAME: Shaffers Crossing Division o" hociamati0nd
-P W&ft *nd Saf;
AINNNERSARY DATE: June 16, 2008
ANNUAL FEE DUE: $5323.00 (Due on or before your anniversary dare)
COCJNTY: Jefferson
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 currerit disturbattees to affected land,
reclamation accomplished to date and during the precc;ding year, now disturbances that are anticipated to oecur
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 our revised written annual report and annual r,,ort ma to this form. The Annum Report
& Fee requirement is not met until we have received the following components' fee. reuort, nrtd ago_c_iaterl
ma . If no n #w di srlaanees or reclamation have oeaurred during the previous vear an no new ch n es to
vn"nirf*d_ mravided that Ih@ Opprator shall state
this in the Annual Report are Please note that are adaq uutely labeled map that clearly delineates and includes the
above elements may sztfloe for a wrilton report.
Division records indicate the following permittec contact information. Please verify and make any necessary
changes-,
pertnittee Contact Juliet A_ Moores
P=ittee Name;
Address:
Phone NumbcFr:
Fax Number:
If you
-fi3 0 aA- fit/ ? r
Elk Creek Sand & Gravel, LLC
P.O. Box 416
11 ?!
Conifer, CO 80433 Lam' ? /
[phone]
az'i- CAUAZ
r `
?l comments and/or information that should ba provided to the Division, please provide it
it to this form along with your written report and map. Annual Report instructions stye and
Signature C or 1 er, Owner, or Designee 6,jWjAqeb
TO 39Vd Vi 19 T QNaS A33dD A-13 LVTL9T8EOE 9E:VT 8OOZ/6Z/LO