2004-09-07_REPORT - M1990098

• Permit No: M1990098
• IBM Index Class Name: REPORT
• Doc Date: 9/7/2004
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Paving Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNP/ERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Asphalt Paving Company
M-1990-098
Perry Pit
September 29, 2004
RECEIVEL
SEP 0 ~~ 2004
Divisioe e: t~;:..,~ .,, 4saio4Y
$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 current distwbances to affected land,
reclamation accomplished-to`date-and-during the'preceding-year, ncw-disturbances-that-are-anticipated to-occur
during the upcoming year, reclamation that will be performed dwing 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 anneal report and annual re~nrt m n 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 pennittee 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: [phone]
Fax Number: [phone]

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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.
Signature of Corporate Officer, Owner, or Designee ~
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Date