2004-05-07_REPORT - M1998032

• Permit No: M1998032
• IBM Index Class Name: Report
• Doc Date: 5/7/2004
• Doc Name: Annual Fee/Report/Map
• From: Sedgwick County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
VTTAT. FF.F, and RF.PnRT RF,(liIF.ST
RECEIVED
Sedgwick Couuty ~Y 07
M-1998-032
Division of Minerals and Geology
Skold Pit
May 27, 2004
$281.00 (Due on or before your anniversary date)
Sedgwick
s
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'-shall submit the annual fee, a report and map showing the extent of current disturbances to affected
-land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the comir[g year,"the 6a[es for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach yn rr revised written anmral report and annual rennrt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Randy Renquist
Permittee Name: Sedgwick County
Address: 223 S. Cedar St.
Julesburg, CO 80737
Phone Number: [phone]
Fax Number: [phone]
~a~ ~hG'IUS-e~
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of orporate O rcer, Owner, or Designee
q-~ 4
Date
M:~PERMITMASTERDOCUMENTS~hI-AF-04