2008-09-15_REPORT - M2004030 - Laserfiche WebLink

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ale- PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ij? ,?WT ANNUAL FEE and REPORT REOUEST AT Bone Stone, Inc. &4I-2004-030 T Bone Stone Quarry September 13, 2008 gscF?VEU /- 15 2000 Division of pwclamabon, ring and Satet! $323.00 (Due on or before your anniversary date) Boulder 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 tc date and during the-preceding year; n thaw ieipated4e=oeeuf dktr-ing-tl2e upce irlg 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 may. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous vear's map are necessarv. 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 suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Bill Tenore Permittee Name: Address: Phone Number: Fax Number: If you have addi attach it to this4 T Bone Stone, Inc. 2337 Emery St Longmont, CO 80501 (303) 324-5021 (303) 776-3839 O'D it nts and/or information that should be provided to the Division, please provide it below or along wit your written report and map. Annual Report instructions are enclosed. ,%gTTff5T16-oT1Nfp_orate Officer, Owner, or Designee