2003-09-19_REPORT - M1995063

• Permit No: M1995063
• IBM Index Class Name: Report
• Doc Date: 9/19/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNTiAT, FF.F. and RF.PnRT RF,(~TiF.ST
RECEIVED
PERMITTEE NAME: Logan County SEP 19 2003
PERMIT NO.: M-1995-063
OPERATION NAME: Schumacher Pit Dirision ~f Minerals and Geology
ANNNERSARY DATE: September 15, 2003
ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date)
COUNTY: Logan
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
___ _operator_shall_submit_the_annual fee, a report and map showing the extent of current disturbances to affected- _
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written anmlal rennrt and anmlal rennrt main to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Byron D. Hickox
Permittee Name:
Address:
Logan County
315 Main St.
Sterling, CO 80751
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signatu a of Corporate Offi er, Owner, or Designee
~~i~/3
Date
M:~PERMI7UTASTER DOCUMENTSVv7-AF-04