2010-01-25_REPORT - M1985112 - Laserfiche WebLink

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)ep ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: Loloff Construction, Inc. PERMIT NO.: 'I-1985-112 OPERATION NAME: Loloff Mine ANNIVERSARY DATE: February 4, 2010 ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) COUNTY: Weld RECEIVED X25zoo ®Ivlalon of Reclamation, 4-0 Mining & Safety 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 durirrg-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 necessary, then no new man is required, provided that the Ooerator 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: Don Loloff Permittee Name: Loloff Construction, Inc. Address: P.O. Box 518 206 Hill St. Kersey, CO 80644 Phone Number: (970) 353-1621 Fax Number: If you have additional comments and/or information that should be provided to the Division, please provide it below or attach ' to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Office ner, or Designee Date