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~~L <br />PERMITTEE NAME: <br />PERMff NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Nienhaeser CoastruMioo & Excavating Co <br />M-2001-018 <br />Schumacher II <br />April 19, 2004 <br />R~~~~~ -u <br />MaR ~ , ~, <br />Division o/ Minerals antl <br />c°0bar <br />$281.00 (Due on or before your anniversary date) <br />Logan <br />According to C.R.S. 34-32.5-1 ] 6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />- s}ia71 submit the annual"fee; it report aii~-map showing"`t}(e'ezfenTVf-current-disturbancesto-affected }and,--- - <br />reclamation accorrtplished 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 />PIr s~atta~yonr revised writt n anon 1 rpnnrt 9nd anm~al rennrt my~ to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Keith Nienhueser <br />Permittee Name: Nienhueser Construction & Excavating Co <br />Address; 1500 10th Ave. <br />P.O. flox 173 <br />Phone Number: <br />Fax Number: <br />Sidney, NE 69162 <br />(308)254-3453 <br />(303) 254-3455 <br />IF you have additional corrnnents 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 enclosed. <br />_i <br />Si alure of Corporate Officer, Owner, or Designee <br />_3_ R-~~ <br />Date <br />'~/~-5 <br />