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~" <br /> <br /> <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVE® <br />PERMITTEE NAME: Logan County <br />PERMIT NO.: M-1978-146 DEC 0 9 T002 <br />OPERATION NAME: Stephens Pit Division of Minerals and Geology <br />ANNIVERSARY DATE: October 1, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Logan <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 <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during [he coming year, the dates for the <br />beginning of active operations, and [he date active operations ceased for the year, if any. <br />Please attach your 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 <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: a°~-~r <br />Permittee Name: Logan County <br />Bvron ~1~kox <br />Address: 315 Main St. <br />Sterling, CO 80751 <br />-°---Phone-Number: -(303) 522=7879-- - '- <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 [his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~. j <br />Signature of Corporate Office ,Owner, or Designee <br />ll~ao~b~ <br />Dale <br />M:~PERMITMASTERD000MENTSNI-AF-04 <br />