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~ r <br />ANNUA FEIk and REPORT REQUEST <br />PERMIT"I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />~M-1995-063 <br />Schumacher Pit <br />September 15, 2007 <br />Q'~ <br /> <br />~--AUG ;. -- 2007 <br />Division of ~eclarr~ation, <br />"Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />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 "sfiall`sulimit the annual fee; areport-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 vour revised written annual reuort and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's mau are necessary, then no new mau is reanired, nrovided that the <br />Operator shall state this in the Annual Resort. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: ffnstin~-lvl~ormick <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />If you have <br />below or a <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />(970)522-7879 <br />(970)522-4018 <br /> <br />Tonal comments and/or information that should be provided to the Division, please provide it <br />it to this form along with your written report and map. Annual Report instructions are <br />~~ <br />Sigfiature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITVv1ASTERD000MENTS~M-AF-04 <br />