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ANN~L FETE a' nd PORT REQUEST <br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/I{i wa County <br />~iooo-oa8 <br />Schmidt Gravel Pit <br />August 28, 2007 <br /> <br />REG~~~~D <br />~(UG 0 2 2001 <br />ision otaR d Safety n <br />Mining <br />$323.00 (Due on or before your anniversary date) <br />I{iowa <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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred durine the previous year and no <br />new changes to the previous year's man are necessary, then no new man is repuired, 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 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: Allen W. Watts <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Kiowa County <br />CF.PR.address_1 <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719)438-5327 <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. f( <br />/__i~~Gfi~' <br />Sign ure of Corporate Officer, Owner, or Designee <br />7- 3D- 07 <br />Date <br />MiPERM111MASTERDOCUMENTSVv1-AF-04 <br />