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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COLIN"fY: <br />Schmidt ConstrucHou Company <br />M-1976-009-HR <br />Menzer Quarry <br />December 31, 2005 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br />DEC ~ 0 2005 <br />Division of Mieerals and Geology <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 operator <br />- __ shall snbrnit the_annLl fee, a report and map chnwing the elct~ent of c'*rt'~disturbances to affected .land. <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach y~r revised written anneal report and anneal report main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Scott Davis <br />Permittee Name: Schmidt Construction Company <br />Address: 2635 Delta Dr. <br />Colorado Springs, CO 80910 <br />--- .-Phone Number: --(7-19) 392-4207--~-, - - - -- <br />Fax Number: (719) 392-4245 <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 this form along with your written report and map. Annual Report instructions are enclosed. <br />__=~~~~ u <br />Stgnature of Corporate O ficer, Owner, or Designee <br />1/~l(-Os~ __ <br />Date <br />