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<br />(,~ A ~i~ <br />4 /V <br />ANNiiAf, FF.F, and RF.PnRT RF,QiTFST <br />PERMITTEE NAME: Logan County : ; ~ „J <br />u,-,, : - - <br />PERMIT NO.: M-1978-146 <br />OPERATION NAME: Stephens Pit <br />ANNIVERSARY DATE: October 1, 2004 <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 />operator shall submit the annual fee, a report and map showing the extent of cuttent disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, rew disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal report and annnal report m T to Chic form. Please note that an <br />adequately laheled 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 />Pecmittee Contact: Byron D. Hickox <br />Permittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <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 this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Owner, or Designee <br />/~/a9/off <br />Date <br />M:IPERMIThfASTERDOCUMEM'SN1-AF-04 <br />