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<br /> <br />RECESVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />M-1987-159 <br />Guenzi S & G Pit <br />December 28, 2003 <br />DEC 2 6 2003 <br />Division of Minerals & GvvlogY <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 ym~r revised written anm~al report and anneal rennrt martn this Tnrm- please note that an <br />adequately labeled map that clearly de/ineates 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 />Pemtittee Contact: Byron Hickox <br />Permittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: <br />Fax Number: <br />(970)522-0888 <br />(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 />Le.~t L <br />Signa a of Corporate Off er, Owner, or Designee <br />~a~a~~o3 <br />Date <br />M:~PERMITU-1ASTERD000M ENTSVN-AF-00 <br />