2010-07-08_REPORT - M1987092 - Laserfiche WebLink

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AT- r ANPWAL FEE and REPORT REOUE_ST PERMITTEE NAME: q Jordan C. and Jone L. Burdick PERMIT NO.: ?M-1987-092 OPERATION NAME: B & G Stone ANNIVERSARY DATE: August 25, 2010 ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) COUNTY: Larimer JUL 0 8 2010 Diwaig Of R*c 149 Od , 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, reclamationacomp-tished to-date-and-during-the-preceding-year,new-disturbances4hat--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 year's map are necessary, then no new may 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: Jordan C. Burdick Permittee Name: Jordan C. and Jone L. Burdick Address: P.O. Box 1385 Phone Number: Fax Number: Lyons, CO 80540 (303) 823-5943 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