2011-02-17_REPORT - M2000059 - Laserfiche WebLink

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P U ?? '' r FEian PORT REQUEST x?? W PERMITTEE NAME: G roux Gravel PERMIT NO.: -2000-059 OPERATION NAME: Geroux Gravel ?'?' _:rs `' f °vj"ration, ANNIVERSARY DATE: February 22, 2011 ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) COUNTY: Custer 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-fa date arid-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 man 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 durin the previous year and no new chap es to the previous year's may 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 suffice for a written report. -- -Division-records indicate the following permittee contact information. -Please verify and 4nake-any n=ssary_. changes: Permittee Contact: Darrell Geroux Permittee Name: Geroux Gravel Address: 1100 CR 160 Westcliffe, CO 81252 Phone Number: (719) 783-2709 Fax Number: (719) 783-2709 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, Own , or Designee Date