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n hp <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'~ Kit Carson County <br />t/ M-1989-003 <br />Raymond Schulte Pit <br />April 5, 2006 <br />REC~iV~D <br />MAR 0 ° 2006 <br />~Drvision of Minerals and G@@logy <br />$688.00 (Due on or before your anniversary date) <br />Kit Carson <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 />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 j~nnr revised written annual red nrt and annual re~nrt mgly 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lyn Brownfield <br />Permittee Name: Kit Carson County <br />Address: 251 15th St. <br />P.O. Box 160 <br />Burlington, CO 80807 <br />Phone Number: ~ (719) 346-8139 <br />Fax Number: (719) 346-7242 <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 is form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signdtufe ofCorpor'dtcfOffi~?; Owner, or Designee <br />Date <br />M:~PERMI74NASTERD000MENTSNI-AF-04 <br />