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<br />fl~~ ~P~ <br />ANNUAL FEE and REPORT REQUEST ~( <br />PERMITTEE NAME: Popejoy Construction Company, Inc. <br />PERMIT NO.: M-1986-124 ~ ~CE~~ <br />OPERATION NAME: Cecil II Gravel Pit (~ ~ 5 2~] ~' <br />ANNIVERSARY DATE: October 24, 2007 t)i~&ond <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) ~tB~dsafey i% <br />COUNTY: Washington <br />_ According to C_R.S. 34-32.5-116 or C.R.S. 34-32-116~eac)~ear, on the_ann_ iversary date of th~ermit, an operator_ _ <br />shall submit the annual fee, a report and map showing the extent of current 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 vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the arevious vear and no new chanties to <br />the previous year's map are necessary, then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suj~ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Donald G. Popejoy <br />Permittee Name: Popejoy Construction Company, Inc. <br />Address: P.O. Box 385 <br />/ S, ~ ~ ~~ <br />Ulysses, KS 67880 <br />Phone Number: (620) 356-3404 <br />Fax Number: (620) 356-4788 <br />1PS~~~ ~~ri~ <br />Cz3~) ~7~ - ~6i7 <br />t'z3~) 77S - 9la-zl <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 />Signature of Corp to ffi ,Owner, or Designee <br />/G 3~0~ <br />Date <br />