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~.. <br /> <br />iiiiiiiiiiiiiiuiii 1~a101 <br />ANNUAL REPORT <br />t~~~~~~~.It''~ <br />PERMITTEE NAME: Phillips County °' <br />PERMIT NO.: M-1983-050 APR 18 2000 <br />OPERATION NAME: State Land-Jensen Pit pi'nsior.ofMiner~lcg,~@p~~ <br />ANNNERSARY DATE: April 28, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $225.00 <br />COUNTY: Sedgwick <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. <br />Please note lhnt an adeyaately labeled map that clearly delineates and includes the above <br />elemerus may sake for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Randy Schafer Company: Phillips County <br />Address: 221 5. Interocean Phone No.: (970 ) 854-3778 <br />Holyoke, CO 80734 FAX No.: ( 970 ) 854-3811 <br />[f there aze additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />_ l L!//.n.LYd YI /°.Nnt~f~C/V 7 / ~ // D <br />Signatur f Corpora Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M ~PERMITV.7ASTERD000AIEMSNI-AF-bI <br />