Laserfiche WebLink
PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ac. ^.arding�to_C- R:S:- 34 =32 -5 =11 or CR:S, 34- 32=11- 6 otrthe_ anniversary _date_.Qf_the._permit_ an <br />operator shall submit the annual fee, a report and map showing the extent - of current- disturbances -to affected --_ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: (970) 381 -4402 <br />Fax Number: <br />If you have additional comments and /or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Si . tune of orpor e Of cer, Ow er, or Designee <br />Date <br />Nunn, CO 80648 <br />M:IPERMITIMASTERDOCUMENTS\ -AF -04 <br />Debbie Shipps <br />Shipps Farms L.P. <br />17164 WCR 100 <br />F ° RPT <br />ANNUAL FEE and REPORT REQUEST <br />4 -Shipps Farms L.P. <br />.I- 1978 -102 <br />Shipps Pit <br />June 29, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Weld <br />970 3? f— o 4g 9 t <br />pstl <br />RECEIVW <br />iiiJN 29 2011 <br />Division of reclamation, <br />" Mining and Safety <br />c7 K, <br />