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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Sedgwick County RECEIVED <br />PERMIT NO.: M-1997.061 AUT7 2 Q <br />OPERATION NAME: Kinnie Gravel Pit Division of Minerals and Geology <br />ANNIVERSARY DATE: September 5, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Sedgwick <br />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 <br />- operator-shall-submit-the-annual-feP,_a-report-and_map_showing-the-extent-of_currentdisturbances to_affec[ed___ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year; if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Randy Renquist <br />Permittee Name: <br />Address: <br />Sedgwick County <br />223 S. Cedar <br />Julesburg, CO 80737 <br />Fax Number: (970) 474-3558 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below_or attach it to [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Sig~n~atur- e of CorTporate Off~cer, Owner, or Designee <br />n-~ ~-O 2- <br />Date <br />M:~PERM nVN ASTERDOCUMENTSU1-AF-04 <br />