2004-08-18_REPORT - M1997061

• Permit No: M1997061
• IBM Index Class Name: Report
• Doc Date: 8/18/2004
• 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:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Sedgwick County
M-1997-061
Kinnie Gravel Pit
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RECEIVED
AUG 1 g 2004
September 5, 2004 Division u. r,iirerals and Geology
$281.00 (Due on or before your anniversary date)
Sedgwick

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 coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annnal rennrt and annnal report mar in chic form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice 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
Julesburg, CO 80737
Phone Number: [phone]
Fax Number: [phone]
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.
Sigpn~ature of Corporate Ifficer, Owner, or Designee
O^~~-©
Date
M:~PERMITMASTERD000MENTSNI-AF-04