2011-06-06_REPORT - M2000028 - Laserfiche WebLink

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z ANNUAL FE'S and IkEPORT REQUEST PERMITTEE NAME: Mike A Ferrero JUN U S 0 ;1 PERMIT NO.: 1114-2000-028 OPERATION NAME: J' Ferrero Pit11W Of Rnbal Mtntng&g?p?y ANNIVERSARY DATE: April 26, 2011 ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) COUNTY: Huerfano 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 tha-f will be performed during the coining 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 man 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 suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Mike A. Ferrero Permittee Name: Mike A Ferrero Address: 34320 Hwy 12 Trinidad, CO 81082 Phone Number: (719) 846-2176 Fax Number: (719) 846-2176 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