2009-05-11_REPORT - M1978327

• Permit No: M1978327
• IBM Index Class Name: REPORT
• Doc Date: 5/11/2009
• Doc Name: Annual Fee/Report/Map
• From: Jake Kauffman & Son, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: ECS
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Ole
AN AL ft and REPORT REQUEST
Jake Kauffman & Son, Inc
?M-1978-327
Kauffman Pit
e- C S
RECOYM
"MAY 1 1 2009
Di%4aion of R°clamatio",
M*19 and Safety
May 14, 2009
$$791.00 (Due on or before your anniversary date)
Larimer
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
ufmg t e upcoming year, rec amation tTiat wilTb`e performed`during the commg year, the dates for the begmnmg
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 year's map are necessary, 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: Mary Kauffman
Permittee Name: Jake Kauffman & Son, Inc
Address: 808 SCR 9E
Loveland, CO 80537
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.
Signature Co orat Iffic, Owner, Designee
Date