Laserfiche WebLink
} <br />V4 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: PCity of Greeley T3 n 2010 <br />PERMIT NO.: v,41-2002_020 Divit?sn csr ?w;ciainakon, <br />OPERATION NAME: 25th Avenue Site Lftkg and Safety <br />ANNIVERSARY DATE: May 30, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />e???,ring ?g?RyS. 34-32.5-11 or C.R.S. 34-3:2-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showin g the extent o current disturbances to affeaed- --- - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Suzanne Bassinger <br />Permittee Name: City of Greeley <br />Address: 1100 10th St., Suite 300 <br />Greeley, CO 80631 <br />Phone Number: <br />Fax Number: <br />(970) 350-9804 <br />(970) 350-9805 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />M: TERMITWASTERDOC LJWNTS\M-AF-04