2010-12-20_REPORT - M1999069 - Laserfiche WebLink

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PERMITTEE N ME: PERMIT NO.: OPERATION NA ME: ANNIVERSAR DATE: ANNUAL FEE D UE: COUNTY: l L FEE and PORT REQUEST IZ-1 e Kauf fman & Son, Inc 999-069 Wagner/Kauffman Pit l#3 e,GS R'!?Cirir v) l/o°_` 2 0 2010 Division ct Reclamation, & January 5, 2011 $$791.00 (Due on or before your anniversary date) Larimer According to C. 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 upco mg year, reclamation that will be performed during the coming year, the dates for-the beginning of active operati ns, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report ma to this form. The Annual Report & Fee require ent 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 revious a is ma are necessary, then no new ma is re uired provided that the Operator shall state this in the Ann al Report. Please note that an adequately labeled map that clearly delineates and includes the above elements ay suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Permittee Name: Address: Phone Number: Fax Number: Frank Kauffman Jake Kauffman & Son, Inc 808 SCR 9E Loveland, CO 80537 (970) 667-1557 (970) 667-9985 If you have add'tional comments and/or information that should be provided to the Division, please provide it below or attach i? to this form along with your written report and map. Annual Report instructions are enclosed. , Owner, of Designee Date // b ?