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~~C <br />- ~ .. <br />ANNUAL FEE and REPORT REQUEST .f~~:e~~t~ ' ~~~ <br />PERMITTEE NAME: Logan County ~ `~® ~~on• <br />//~vo ~ Ftec~aa erl <br />PERMIT NO.: ~1GI-1978-146 0 5\o~~oga,~dS <br />OPERATION NAME: Stephens Pit ~~~o <br />ANNIVERSARY DATE: October 1, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: 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 sfiall`submit the annual- fee,-a~ report and map-showing `the -extent-of-current ~disturbanees -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. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated map. If no new disturbances or reclamation have occurred durinS the previous year and no <br />new changes to the urevious year's mau are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (303) 522-7879 <br />Fax Number: (970) 522-4018 <br />~C': S 1 'e. v~ n : +~ <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 />Si ature of Corporate Offi or Owner <br />Date <br />