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~ ~YJ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COIJN"I Y: <br />Schmidt Construction Company <br />M-1988-044 <br />Coal Creek Resources <br />March 28, 2005 <br />RECE~v ED <br />MAR 2 2 2005 <br />piuiston st MiMe~els and Geolo9V <br />$688.00 (Due on or before your anniversary date) <br />Arapahoe <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, ,_ _ <br />-reclamation-accomptished to dafe and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual rennrt and anm~al re~nrt man to this form. Please note that an <br />adequately labeled map that clearly 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: Scott Davis <br />Permittee Name: Schmidt Construction Company <br />Address: 2635 Delta Dr. <br />Colorado Springs, CO 80910 <br />_ _~hone Number:_- _(7_I9) 392-_4207. <br />Fax Number: (719) 392-4245 <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 enclosed. <br />Signature of orporate Of icer, Owner, or Designee <br />~~ ~U'~ <br />Date <br />