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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Schmidt Construction Company <br />M-1976-009-HR <br />Menzer Quarry <br />December 31, 2002 <br />RECEIVED <br />DEC 3 1 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />El Paso <br />According to C.R.S. 34-32.5-1 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />_ reclamation accomplis~d <o da[e and du~mg the piece t3~ng year, new disturbances [hat are anticipated [o occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach vour revised written annual report and annual resort mau to this form. Please note that an <br />adequately labeled map that clearly delineates mtd includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessazy <br />changes: <br />Permittee Contact: Scott Davis <br />Permittee Name: Schmidt Construction Company <br />Address: 2635 Delta Dr. <br />Colorado Springs, CO 80910 <br />Phone Number: (719) 392-4207 <br />Fax Number. '~~ ~ -~ g~ - ~(02 ~,.$"-' <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 />~~ -Cl,' <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERM ITUNASTERDOC UMENTSNI-AF-01 <br />