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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Schmidt Construction Company <br />M-1982-155 <br />Fountain Pit <br />December 31, 2003 <br />$688.00 (Due on or before your anniversary date} <br />EI Paso <br />RECEIVED <br />DEC3020~ <br />Division ~f Minerals and 6eolo~y <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116,_each year, on the_anniversary_date ofihe_permit, an operator <br />-shall submirthe-annuat-fee,-a-report and-map showing-the-extetrt-af-current-disturbances-to-affected land- - <br />reclamation accomplished to date 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 anneal report and annual 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 report. <br />Division records indicate the following petmittee 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 />_ _ _ Phone Number: (719) 39211207 _~_- _._ <br />Fax Number: (719) 392-4245 <br />If you have additional comments andlor information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />_ r- o <br />Date <br />M:\PERMITMASTERDOCUMENTSU~I-AF-01 <br />