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"-- f <br /> <br />µ~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Phillips County <br />PERMIT NO.: IVI-1983-050 <br />OPERAT[ON NAME: State Land-Jensen Pit <br />ANNNERSARY DATE: April 28, 2000 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: 5225.00 <br />COUNTY: Sedgwick <br />III IIIIIIIII IIII III <br />999 <br />~~~~~~~~ <br />'JUN 13 20D0 <br />Ditnsion ol~li~erals & (ieolcgy <br />According to C.R.S. 34-32- l 16(3)(a), 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 <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. <br />Please note that an adequately lnbeled map that clearly delineates and includes the above <br />elements may suffice for a >.vritten report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Randy Schafer Com an Phillips County <br />P Y~ <br />Address: 221 S. Interocean Phone No.: (970 ) 854-3778 <br />CO 80734 FAX No.: ( 970 ~ 854-3811 <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />SignatureLof Corpora Officer, or Owner Date <br />/NSTRUCTIONS ON BACK <br />AI IP E R M1I IN7 A ST E R DOC U M1I E M S~\ I ~.\ F-0~ <br />