2010-10-01_REPORT - M2000089 - Laserfiche WebLink

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P?--- PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE ANNUAL FEE DUE: COUNTY: & A FEE`and REPORT REQUEST C Z acio Vasquez Sr 2000-089 Perdue October 4, 2010 ?0"C" 012010 DM&ion of Mj ciiar?ati?sn, MM2r.g aid Safety $$323.00 (Due on or before your anniversary date) Boulder 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 map are necessarv. then no new map is reauired, 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 suff ce for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Ignacio Vasquez Sr Permittee Name: Ignacio Vasquez Sr Address: I'.O. Box 938 Phone Number: Fax Number: Lyons, CO 80540 (303) 823-5684 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. G?rrr? Signature of Corporate Offic wn , or Designee q?301 (0 Date