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i <br />RECEIVE. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Cheyenne County <br />M-2000-018 <br />Munsch Pit <br />May 2, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Cheyenne <br />MAY 0 3 2002 <br />Givision of Minerals and Geola,. <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 pemtit, 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 [o 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 farm. Please note that an <br />adequately labeled map that clearly 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: Nancy Bogenhagen <br />Permittee Name: Cheyenne County <br />l~O~,Y~ ~-1'~flixsCjlr~ur,i-.t ~dm~n~S~t'~tir <br />Address: P.O. Box 567 <br />Cheyenne Wells, CO 80810 <br />Phone Number: (719) 767-5872 <br />Fax Number: (719) 767-5540 <br />If you have additional comments and/or information that should be provided [o 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 />Signatu~ of Cot~~i-p~te Officer or Owner <br />y-a ~i-o~ <br />Date <br />M:IPERMITMAS7ERDOCUMENTSU1-AF-01 <br />