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:~ ~~ ® III IIIIIIIIIIIIIIII <br />ANN~JAL 1(r,rwJn i <br />~~ `~ <br />PERM]TTEE NAME: Phillips County J <br />PERMIT NO.: M-90-116 <br />OPERATION NAME: Kennedy Pit <br />ANNIVERSARY DATE: October 26, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Phillips <br />•~,,.c.~ ct ~4Sinarala ~ Geology <br />According to C.R.S. 34321 lE(3)(a), each yeas, on the anniversar; date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annuar. report. Pease mote that atr adequately labeled rrsap that cleverly delineates and <br />includes the above elements may saffice jor a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Randv Schafer <br />Address: 221 S. Interocean <br />Holyoke, CO 80734 <br />Company: <br />Phone No.: ( 970 ) 854-3778 <br />Fax No.: f 970 ) 854-3811 <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written n;port. <br />~~ ~/ ~a/i9~99 <br />Signature: Corporate fficer, or Owner Date <br /> <br />~~~, ~ <br />~~ 1 <br />' J <br />'~ <br />`. <br />~~ ~~~C~il1rE:: <br />INSTRUCTIONS ON BACK <br />