2009-05-01_REPORT - M2006024 - Laserfiche WebLink

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ANNUAL FEE and REPORT REOUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Carrizo Stone, LLC M-2006-024 Carrizo Stone South May 3, 2009 $$323.00 (Due on or before your anniversary date) Baca OK j6d ?,Ay p 2009 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 .yeax,ew-distubanees that= are xrrtiipated to csceur - - 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 reauired, 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: Stephanie and Ray Sikes Permittee Name: Carrizo Stone, LLC Address: 1425 County Road Q Pritchett, CO 81064 Phone Number: (719) 643-5325 Fax Number: (719) 643-5327 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. Signat of Corporate Officer, O er, or Designee q - AI -0'rl Date