REP39196

• Permit No: M1990098
• IBM Index Class Name: Report
• Doc Date: 8/22/2002
• Doc Name: 2002 Annual Report
• From: Asphalt Paving Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Asphalt Paving Company
M-1990-098
Perry Pit
September 29, 2002
RECEIVED
AUG 2 2 2002
Division of Minerals and Geology
$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_[he_ex[ent_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 Your revised written annual report and annual report map to this form. 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 any necessary
changes:
Permittee Contact: Jeff Keller
Permittee Name: Asphalt Paving Company
Address: 14802 W. 44th Ave.
Golden, CO 80403
Phone Number:
Fax Number:
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to [his form along with your written report and map. Annual Report instructions are enclosed.
Officer, Owner, or Designee
Date
M:~PERM IT\MASTERDOCUM ENTSUI-AF-01