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999 <br /> __11GG <br /> ANNUAL FEE and REPORT REOUEST Gv`vvO <br /> Ak <br /> PERMITTEE NAME: Logan County C��4Q e`o`ssiA <br /> PERMIT NO.: '-!Yj -/9 87-169 <br /> OPERATION NAME: "o n Z-; t t 0 <br /> ANNIVERSARY DATE: bcu-mbcr .27 <br /> ANNUAL FEE DUE: (Due on or before your anniversary date) <br /> tn88 00 <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 current disturbances to affected <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 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 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: Ken Strohson <br /> Permittee Name: -bsgaa_Couuty 6 (ou-u�1 <br /> Address: 315 Main St. <br /> Sterling, CO 80751 <br /> Phone Number: t3ffa)�22�$99 9 O 5,20 7 F79 <br /> Fax Number: 9 70 ) s as - `/ O ! S' <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 /> 0tr4tn_ <br /> Signature of Corporate Officer or Owner <br /> Date <br /> M 9PERMrM1ASTFRD0CUMENTS VA-AF-Oc <br />