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~~; o~Pi <br />ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: / Sc alz Constructiou Ltd. <br />PERMIT NO.: ! -1984-069 <br />OPERATION NAME: Schmalz Const Pit <br />ANNIVERSARY DATE: July 12, 200 ~~ 3 <br />ANNUAL FEE DUE: $~0 (Due on or before your anniversary date) <br />COUNTY: Gunnison <br />~ <br />Ot~tsio U( Z©~ ~U <br />Miai~9a drat' a~~~ <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 />- --reclamatiorraecoriplished-to-datcand-during-the-preceding-year; new-disturbances-that-are'antiaipated-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 report mau to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Fred Schmalz <br />Permittee Name: Schmalz Construction Ltd. <br />Address: 720 S. 8th St. <br />P.O. Box 1105 <br />Gunnison, CO 81230 <br />Phone Number: (970) 641-2014 <br />Fax Number: (970) 641-4231 <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 enclosed. <br />Signature of Corporate Officer, O er, or Designee <br />7/~~ <br />Dat~ <br />