2008-12-16_REPORT - M2000092

• Permit No: M2000092
• IBM Index Class Name: REPORT
• Doc Date: 12/16/2008
• Doc Name: Annual Fee/Report/Map
• From: City of Walsenburg
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REOUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
City of Walsenburg
M-2000-092
Walsenburg Gravel Pit
December 14, 2008
$323.00 (Due on or before your anniversary date)
Huerfano

?IVIStiD'. ,
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 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: Eric Pearson
Permittee Name: City of Walsenburg
Address: 525 S Albert
Walsenburg, CO 81089
Phone Number: [phone]
Fax Number: [phone]
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.
ignature of Corporate Officer, Owner, or Designee
t2? 3109
Date
M: PERMIT\MASTERDOCUMENTS\M-AF-04