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ANNTiAi, FF.F, and REPORT RF.nTiF.fiT <br />PERMITTEE NAME: Logan County <br /> _ <br />. <br />J <br />: ! ~ <br />~ <br />PERMIT NO.: , <br />. <br />,., <br />M-1978-249 - <br />OPERATION NAME: Kokes Gravel Pit <br />ANNNERSARY DATE: October 1, 2004 <br />ANNUAL FEE DUE: $688.00 (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 <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 annnal re~prf and annnal re r~i t man to this fnrm_ 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: Byron D. Hickox <br />Permittee Name: Logan County <br />Address: 315 Main 5t., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-0888 <br />Fax Number: (970) 522-4018 <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 />~'J `C//mod <br />Signature f Corporate Officer caner, or Designee <br />/ a9 0 <br />Date <br />M:~PERMI7UTASTERD000MENTSNI-AF-O4 <br />