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i:, <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />M-1978-249 <br />Kokes Gravel Pit <br />October 1, 2003 <br />DEC 2 6 2003 <br />Division of Minerals & Geology <br />$688.00 (Due on or before your anniversary date) <br />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 />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 ynnr revised written annnal report and annnal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 D. Hickox <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St. <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 />~~ <br />Signature f Corporate Officer caner, or Designee <br />/a~a3~o3 <br />Date ~~ <br />M:~PERMnIMASTERDOCUMENTSUr-AF-04 <br />