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<br />AF ~ ~,P~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Logan County ~~ <br />M-1978-249 <br />Kokes Gravel Pit <br />October 1, 2007 <br />RECENED - / <br />SEP 1 `L 2001 v <br />~ggte ~tbn, <br />$$791.00 (Due on or before your anniversary date) <br />Logan <br />---,4ccotding-to-G~.~': 34-32.5-1.1-fi-OV-(;.IL.S.-34=32..1-1.6,-eaCli •~P-y-~~_^_^ +1•e annivercary rlatr of the Hermit, an ~_ _ <br />operator 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 perfonned 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's map are necessary,then no new map is required, provided that the <br />Oserator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: T' ~~^ T. ""°"°-~-~~-'- <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-7879 <br />Fax Number: (970) 522-4018 <br />~, 5 ~.~~ ~ <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 />L <br />Signa a of Corporate O icer, Owner, or Designee <br />Date <br />M:~PERMITMASTERD000MENTS~M-AF-04 <br />