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<br /> <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />1Ciowa County <br />M-2000-048 <br />Schmidt Gravel Pit <br />August 28, 2003 <br />AUG 0 1 2003 <br />Oirision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />iKiowa <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 />opeiator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, 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 yonr revised written annnal report and annnal re~nrt maw to this form. Please note that qn <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: Richard McDaniel <br />Permittee Name: <br />Address: <br />Kiowa County <br />1305 Goff St. <br />P.O. Box 100 <br />Eads, CO 81036 <br />Phone Number: (719) 438-5810 <br />Fax Number: (719) 438-5327 <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 <br />enclosed. <br />V ~ ~, <br />Signature o CoT rporate Officer, Owner, or Destgnee <br />7- 2S- a~ <br />Date <br />M:iPERMITMASTERD000MENTSU}-AF-P9 <br />