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<br />{ N/ <br />/v" " <br />l~ti~ ANNiiAi, FFF, and RF.PIIRT RF.niTF,CT ~+ 1' <br />PERMITTEE NAME: Phillips County REC~'i V ~® <br />PERMIT NO.: M-1990-116 SEP 142004 <br />OPERATION NAME: Kennedy Pit Birision of Minerals and Geology <br />ANNNERSARY DATE: October 26, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Phillips <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 ym~r revised written annual re~nH and anneal report map to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Randy Schafer <br />Pennittee Name: Phillips County <br />Address: 221 S. Interocean <br />Holyoke, CO 80734 <br />Phone Number: (970) 854-3778 <br />Fa:c Number: (970) 854-3811 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMINSASTERDOCUMENTSNI-AF-04 <br />