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V l~ <br />RECEIVED <br />PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: , <br />ANNUAL FEE and REPORT REQUEST <br />MAY 0 8 2002 <br />Division of Minerals and Gealagy <br />Sedgwick County <br />M-1998-032 <br />Skold Pit <br />May 27, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Sedgwick <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he 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 resort and annual resort map to this form. 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 pemtittee contact information. Please verify and make any necessary <br />changes: ,pq <br />Permittee Contact: Randy Renquist Yf/0.(0 ~ n (° ~~ S ~ <br />Permittee Name: <br />Address <br />Sedgwick County <br />223 S. Cedar St. <br />Julesburg, CO 80737 <br />Phone Number: (970) 474-3576 <br />Fax Number: (970) 474-3558 <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 />Signature of C rporate fficer or Owner <br />T4-o2 <br />Date <br />M:~PERM771MASTERD000M ENTSN9-AR04 <br />