2008-09-26_REPORT - M2003016 - Laserfiche WebLink

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o k- ANNUAL FEE an ?OUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: AW Chambers, LLC /M-2003-016 Heit Sand and Gravel Mine September 27, 2008 $791.00 (Due on or before your anniversary date) Weld ?EP 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 are anticipated to 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 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 map. If no new disturbances or reclamation have occurred durin the previous year and no new chap es to the revious year's may 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: Permittee Contact: Mark D. Campbell Permittee Name: SW Chambers, LLC Address: 333 de_aA,,. Ste 810 Engle 0110 Phone Number: (303) 534-1040 Fax Number: 7461) t? iP /R 2 ?t /? S724-. 3 7o s If you have additional comments and/or information that should be provided to the Division, please provide it below or attach i t to this form along with your written report and map. Annual Report instructions are enclosed. 0 4 7-0 P- r?,s Is S' re Corporate ice r, Owner, or Designee Date 1(4,4 P-