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1 <br />,~~- ~P <br />ANNUAL ~E and REPORT REQUEST <br />PERMITTEE NAME: '' Skoglund Excavating Inc. <br />PERMIT NO.: ~ M-1996-089 <br />OPERATION NAME: Skoglund Pit <br />ANNIVERSARY DATE: March 20, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Saguache <br /> <br />~~~ ~~~~ <br />AR 10 2~0~ <br />ision o td~;ca~:s~ation, <br />Mining and safety <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 the 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 to occur <br />~~ - -during-i;he -upco~iing-yf;ar, reclamation that wild -be performed during the coming year, ~flie dates for the "beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Re~port• Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may sub f ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth L. Skoglund <br />Permittee Name: Sl~:oglund Excavating Inc. <br />Address: 11th and Broadway <br />P.O. Box 209 <br />_ - `offal.._CO 81 T43s,. - - - _ ~ ~ - ----_ -~-_ ~ - - - ~_ <br />Phone Number: (719) 256-4447 <br />Fax Number: (719) 256-4447 <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 />Signature of Corporate Officer, Owner, or Designee <br />-~- O~ <br />Date <br />