2012-02-01_REPORT - M1989023 - Laserfiche WebLink

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PERMITTEE NAME: Clyde and Marie Couch PERMIT NO.: M- 1989 -023 OPERATION NAME: Caliche School Pit ANNIVERSARY DATE: March 9, 2012 ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) COUNTY: Logan 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 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. g r Please attach our revised written annual re ' ort and annual re . ort ma . to this form. The Annual Re or & Fee requirement is not met until we have received the following components: fee re ort and associate t maa. If no new disturbances or reclamation have occurred durin o the revious ear and no new chap the • revious ear's ma • are necessa then no new ma • is re uired rovided that the 0 I erator 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 an changes: any necessa ry Permittee Contact: Clyde Couch Permittee Name: Clyde and Marie Couch Address: 122 State St. Phone Number: Fax Number: Sterling, CO 80751 (970) 522 -1239 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 ANNUAL FEE and REPORT RE UEST