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fv~L <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />9'~ <br />~ ANNi1Af. FF.F. and RF.P(1RT RF.t1TiF.ST <br />r/ Schmalz Construction Ltd. <br />1/ M-1984-069 <br />Schmalz Const Pit <br />July 12, 2006 <br />RECE~~'~°D <br />~JUC 0 5 2006 <br />t/pp,isiaa of Minerals and Geologi <br />$281.00 (Due on or before your anniversary date) <br />Gunnison <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 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 xGnr revised written annual refit and annual refit m ~n to this form- The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: st:, re~rt, and associated <br />maR (All 3 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: Fred Schmalz <br />Permittee Name: Schmalz Construction Ltd. <br />Address: 720 S. 8th St. <br />P.O. Box 1105 <br />Gurnison, CO 81230 <br />Phone Number: (970) 641-2014 <br />Fax Number: (970) 641-4231 <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 fRrm along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corj~orate Officer, (]weer, or Designee <br />'7~3~f~ J <br />Dat~ <br />