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<br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cheyenne County <br />M-2000-018. <br />Munsch Pit <br />May 2, 2004 <br />APR 2 7 2004 <br />,~ <br />Division of Minerals & Geology <br />$281.00 (Due on or before your anniversary date) <br />Cheyenne <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />_ ~ operatrzr sh_all_submit_the_annual_fee, a_report andrnapshowing-the-exter_t-o~currexit-disturbances to affected -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmral report and anneal rennrt m T M this form. Please note [hat an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact informatien. Please verify and make any necessary <br />changes: <br />Perrnittee Contact: Lara Crowell <br />Permittee Name: Cheyenne County <br />Address: P. O. Box 567 <br />Cheyenne Wells, CO 80810 <br />Phone Number: (719) 767-5872 <br />Fax Number: (719) 767-5540 <br />Kay Feyh. County Clbxk <br />Cheyenne Count <br />P. 0. Box 567 <br />Cheyenne Wells. CO 80810 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signatur of Corporate Officer, Ow r, or Designee <br />Date <br />M:~PERMInMASTERDOCUMENT$Vvl-AF-04 <br />