2006-10-02_REPORT - M1990098 - Laserfiche WebLink

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~a ion ~irvl W PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: v ANNUAL FEE and REPORT REQUEST t/ Asphalt Paving Company M-1990-098 Perry Pit September 29, 2006 RECEIVED .~~~? n ? ,n~5 Division of Reclamation, Mining and Safety $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 lhe-anntiai° fee; a-re-yart-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 far the beginning of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual resort and annual report moo to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated moo (All are required regardless of the level of disturbance or absence of disturbance during the previous year). Please note that an adequately labeled map that clearly delineates and includes the above elements may since jor a written report, Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Greg Gerganoff Permittee Name: Asphalt Paving Company Address: 14802 W. 44th Ave. Golden, CO 80403 Phone Number: Fax Number: (303) 279-6611 (303)279-6216 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 o~Co orate Officer, Owner, or Des_ ~~ ~-oar' Date