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<br />~/ <br />"^ ~~ ANNTiAi. FF.F, and RF.Pt7RT RF.("~iTFCT <br />U ~G~'. <br />PERMITTEE NAME: Logan County O%I ~ ~ ZQQ~ <br />PERMIT NO.: M-1999-029 Division of ~inetal5 & Geology <br />OPERATION NAME; Bob Terrill Clay Pit <br />ANNPJERSARY DATE: June 22, 2004 <br />ANNCJAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COiJN"I'Y: Logan <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 />PIPACP AttACh yin Ir rPVIC Ii WrlttPn annnAl rel]nrt find 9nm~9i rennrt mAT to thlR form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Byron Hickox <br />Pennittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-0888 <br />Fax Number: (970) 522-4018 <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. <br />Signatu a of Corporate Office ,Owner, or Designee <br />~~~~~ <br />Date <br />M: WERM171MASTEROOC UMENTSUr-AF-04 <br />