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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Schmidt Construction Company it L li+~~ V ~~ <br />PERMff NO.: M-1989-065 APR f s; 1002 <br />OPERATION NAME: Winkler Light Aggregate Quarry Oivisian of Minerals and Geology <br />ANNIVERSARY DATE: Apri126, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <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 thepreccdu-~g-year; reu•-distarbarc~-tltat :a'e-anticipaied=io`oc rttr <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 form. 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: 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: <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 instmctions are enclosed. <br />//~~ /, <br />,ev ~.Elad/Q.~' <br />Signature of Corporate O ficer or Owner <br />.~ ~~~~ <br />Date , <br />M:~PERMI7VNASTERD000MENTSVv1-AF-01 <br />