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<br /> <br />RECEDED <br />MAR 17 2004 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />J and M Schmahl <br />M-1984-001 <br />Surface Rock Pit <br />Apri14, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br />Dlvi8lon of Mi;,: .. ~ GeoloBY <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 operator <br />shall submit ifie annual fee,-a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal rennrt and annnal ~pnrt m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: John Schmahl <br />Pennittee Name: J and M Schmahl <br />Address: 3842 G.7 Rd. <br />Palisade, CO 81526 <br />Phone Number: (970)-464-9168 <br />Fax Number: <br />~L_/'~AMA7ioN ~i7~SG' a ,A'D <br />~PcW !lIfO~GNd ,~/AS °i9.1/ <br />Q';.s~~~ded ~~~~ ~tiC /~s f <br />-Z <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 enclosed. <br />S afore of Corporate OfScer, Owner, or Designee <br />Date <br />