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<br />ANNUAL FEE and REPORT REQUEST RECEIVED <br />PERMITTEE NAME: Skoglund Excavating Inc. MAR ~ ~ ZQQz <br />PERMIT NO.: M-1996-089 Division of Minerals and Geology <br />OPERATION NAME: Skoglund Pit <br />ANNIVERSARY DATE: March 20, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Saguache <br /> <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 the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished_to_date and.during the_preceding.yeaz,.new.disturbances that are anticipated to 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth L. Skoglund <br />Permittee Name: Skoglund Excavating Inc. <br />Address: 11th and Broadway <br />P.O. Box 209 <br />Moffat, CO 81143 <br />Phone Number: (719) 256-4447 <br />Fax Number: (719) 256-4154 <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />3 - !6 - o~- <br />Date <br />M:~PERMI'[ VviASTERDOCUMENTS~M-AF-01 <br />