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r <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />M-1987-159 <br />Guenzi S & G Pit <br />December 28, 2002 <br />FEB 1 q 2003 <br />Division of Minerals and Geology <br />$688.00 (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 the anniversary date of the permit, an <br />__ _ operator shall submit the annual fee, a report and map showing the extent of current 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 your revised written annual report and annual report map 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: Ken Strohson ~'I)/)-O/I {--} 1 r~DX <br />Permittee Name: Logan County <br /> <br />Address: <br />315 Main St. I _ <br />31~ MQlrt 5+,~ SUiT'~Z- <br /> Sterling, CO 80751 <br />Phone Number: (970) 522-0888 <br />Fax Number: (970) 522-4018 <br />If you have additional comments and/or information that should be provided [o 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 />~~~ 5 <br />Signat e of Corporal Office Owner, or Designee <br />Date <br />M:~PERM ITU~IASTERDOCUM ENTSN4-AF-04 <br />