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<br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~' <br />ANNUA ~EE'and REPORT REQUEST <br />Logan County <br />~M-1993-069 <br />Lindstrom Gravel Pit <br />November 26, 2007 <br />R'~GE~vED <br />~ aCT ~ ~ 2001 <br />~i~slon of a d Sa e1Y n, <br />7 Nlinin9 <br />$$791.00 (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 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 annual report and annual report moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. 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: ~-/) _ ~ n,~ - <br />Permittee Contact: Iau~Ein.drkloGetRliele 1~t ~ 5 / - ~~-0.~ <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />(970)522-7879 <br />(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 tach it to this form along with your written report and map. Annual Report instructions are <br />enclose <br />Si afore of Corporate Officer, Owner, or Designee <br />~6 Off' <br />Date <br />M:~PERMITNIASTERDOCUMEN75VA-AF-04 <br />