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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Logan County <br />M-1995-063 <br />Schumacher Pit <br />September 15, 2002 <br />RECEIVED <br />DEC 0 9 2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Logan <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he anniversary date of the permit, an <br />-operator-shall-submit-the-annual-fee,-a-report-and-map_showing_[he_eaten[_of_curcent_disturbances_to affected <br />land, reclamation accomplished [o date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and anneal report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: d'cex-Stfehsex <br />Permittee Name: Logan County <br />Address: 315 Main St. <br />Fax Number: (970) 522-40]8 <br />$~Iran ~ic.kol~ <br />If you have additional comments and/or information that should be provided to [he 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 />E~ .~ ~~I ~~~~ <br />Signatu of Corporate Officer, weer, or Designee <br />//~~0/~. <br />Date <br />Sterling, CO 80751 <br />M: W ERMr7N1ASTERDDCUMENTSIM-AF-04 <br />