2012-02-01_REPORT - M1987028 - Laserfiche WebLink

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Date PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: ANNUAL FEE and REPORT RE UEST Quikrete Materials, LLC M -1987 -028 Lily Mines March 18, 2012 $$791.00 (Due on or before your anniversary date) Chaffee 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 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 our revised written annual re . ort and annual re ort ma & Fee requirement is not met until we have received the following components: fee, re map. If no new disturbances or reclamation have occurred durin. the ' revious the 8 revious ear's ma • are necessa to this form. The Annual Report ort, and associated ear and no new chan rovided that the O • 8 • then no new ma is re uired erator shall state this in the Annual Re above elements may suffice f or a written report es to ort. Please note that an adequately labeled map that clearly delineates and includes the Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Vincent Sadowski Permittee Name: Quikrete Materials, LLC Address: 3490 Piedment Rd., Suite 1300 Phone Number: Fax Number: Atlanta, GA 30305 (404) 634 -9100 (404) 841 -0174 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