2007-04-04_REPORT - M1983039

• Permit No: M1983039
• IBM Index Class Name: Report
• Doc Date: 4/4/2007
• Doc Name: Annual Fee/Report/Map
• From: Las Animas County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~` ~~i
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Las Animas County
M-1983-039
Airport Gravel Pit
Apri128, 2007
~~~ -~ rc~
/ ~ ^,~
~ w.
,.::::
.;t,
$$688.00 (Due on or before your anniversary date)
Las Animas
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 currant 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 vour revised written annual report and annual report mau 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 veer and no
new chances to the previous year's moo are necessary. then no new moo is required, provided that the
Operator shall state this in the Anneal Resort. Please note that an adequately labeled map that clearly
delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phil Dorenkamp
Las Animas County
2000 N. Linden Ave.
Trinidad, CO 81082
Phone Number: [phone]
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
Date
M:~PERMIT~MASTERDOCUMENTS~M-AF-04