2009-11-04_REPORT - M2003001 - Laserfiche WebLink

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L IL ANW AL FEE and REPORT VEST PERMITTEE NAME: all Irwin Corporation / 001 4V 2003 PERMIT NO.: 0 - OPERATION NAME: Nissen Farm Resource ANNIVERSARY DATE: November 21, 2009 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Weld 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 man 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: Jim McFarland Permittee Name: Hall Irwin Corporation Address: 301 Centennial Drive Milliken, CO 80543 Phone Number: (970) 587-7277 Fax Number: (970) 587-7287 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 Date