2007-05-29_REPORT - M2001001

• Permit No: M2001001
• IBM Index Class Name: Report
• Doc Date: 5/29/2007
• Doc Name: Annual Fee/Report/Map
• From: Four States Aggregates, LLC
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
t~'our States Aggregates, LLC
~M-2001-001
Line Camp Pit
Juue 18, 2007
$$68$.00 (Due on or before your anniversary date)
Montezuma
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Oivr•,on o. r,~c:e,n,;;ion,
fining and Safety
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
_ i 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_yeax~new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for`the tieginning-
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 durinc the previous year and no new chances to
the previous year's man 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 [he
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:
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Permittee Name: 4
t~,
Four States Aggregates, LLC _
Address: P.O. Box 1568
Cortez, CO 81321-1568
Phone Number: [phone]
Fax Number: 5-1 5
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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.
Signatur of Corpo •ate Officer, Owner, or Designee
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Date