2009-06-08_REPORT - M1987088 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ANNUAL FEE and REPORT REQUEST Hubbs III, LLC ? M-1987-088 Hubbs Pit v JUN 0 8 2009 ? DivisiGn c` and Saf Yo:?, j ? Mir,-Mg July 14, 2009 $791.00 (Due on or before your anniversary date) La Plata 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-aeeo:nphshed-to--date-and-during the-preceding-year; -new-disturbances-that-are-anticipated-to-occiu- - 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 may 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 may 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 since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Barbara E. Hubbs Permittee Name: Hubbs III, LLC Address: 7994 E Saddleback Dr Kingman, AZ 86401 Phone Number: (928) 692-6208 Fax Number: 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 of Corporate Officer, Owner, or Designee D Date