2010-07-19_REPORT - M1983209 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ANNUAL FEE and REPORT REOUEST /Frank Gilmore / M-1983-209 Benton Dawson Gravel July 25, 2010 Rftw,jm 1/ JUL 19 2010 t? D'nvn of R2c; on, A47nir J and 3 r $323.00 (Due on or before your anniversary date) Delta 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, Feclamaton accornpli'shed-`to date- aril durm' g e preceding year, new disf`ur a-hces tliat 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 man. 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 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: Frank Gilmore Permittee Name: Frank Gilmore Address: 5998 Sawmill Mesa Road Delta, CO 81416 Phone Number: (970) 874-5157 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. Si ature of Corporate Officer, Owner, or Designee 1(?? to Date