2009-10-21_REPORT - M1980201 - Laserfiche WebLink

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Pg *- P-k ANNUAL FEE and REPORT RE VEST 0- PERMITTEE NAME: Mathias Concrete Inc PERMIT NO.: M-1980-201 / OPERATION NAME: O'Bannon Pit ? ANNIVERSARY DATE: October 23, 2009 ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) COUNTY: Rio Grande 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 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-cometg Year;-the-dates for the beginnin g p g 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. 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 during the previous Year and no new changes to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. 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: Thomas G. Mathias v Permittee Name: Mathias Concrete Inc Address: 1500 N. Farm Rd. P.O. Box 266 Monte Vista, CO 81144 Phone Number Fax Number: (719) 852-3732 (719) 852-3759 If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this fonn;-along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Officdr, Owner, or Date