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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Kym A. Schure RECEIVED <br />PERMIT NO.: M-1986-074 <br />OPERATION NAME: Dollerschell Pit JUN 2 7 2002 <br />ANNNERSARY DATE: June 30, 2002 Division of Minerals and Geology <br />ANNUAL FEE DUE: $281.00 (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 operator <br />shall-submit-tha-a»nual-fee,--a-report-and-map-shovri ng-tfie-extent-of-arrrent-disturbar, ces-ta-affected-land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <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 your revised written annual report and annual resort map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffece for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kym A. Schure <br />Permittee Name: Kym A. Schure <br />Address: 12826 CR 37 <br />Phone Number: <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 tki's form along`with your written report a~rnap: nnua ZZep`or[ mstructlons are enclosed <br />r° <br />Sigl ur o//f Corporate Officer or Owner <br />OI ~. /~~ <br />to <br />Sterling, CO 80751 <br />(970)522-9485 <br />M;IPERMITNIASTERD000M EMSNI-AF-OI <br />