2005-09-20_REPORT - M1988048

• Permit No: M1988048
• IBM Index Class Name: Report
• Doc Date: 9/20/2005
• Doc Name: Annual Fee/Report/Map
• From: Andesite Rock Company
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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ANNiTAI, FF.F, and RF.PnRT RF.niTF,ST
A desite Rock Company
-1988-048
~ SEP 2 0 2065
Carr Gravel Resource
September 22, 2005
Division of Afii~.::..:,: ~ =.-.~,,~;
$688.00 (Due on or before your anniversary date)
Weld
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 currenh 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 ynnr revised written annual report and annual re~nrt m ~n to this fnrm_ 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: Lynn Mayer
Permittee Name: Andesite Rock Company
Address: 7321 E. 88th Ave., Ste. 200
Henderson, CO 80640
_ Phone_Number:__(3D3)287=4656_
Fax Number: [phone]
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.
vuicer, owner, or Lesignee
Date