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l~ ~ ~• ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Sedgwick County <br />M-1998-032 <br />Skold Pit <br />May 27, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Sedgwick <br />~~~~i~~~ <br />APR 1 6 2000 (~ <br />Uivisiori of iieclamation, (~~' <br />Mining and Safety <br />__ _-__ . According_to C.R.S. 3.4-3225-116 o~C.R.S._34:3~116,~~ach-Rear, ten- h . ann~~ersaa~.da+~ ~~ +~P.~aRa~~x,aa~...~~-- <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 vour revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary. then no new map is reauired, 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 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 <br />Permittee Name: <br />Address: <br />Randy Renquist <br />Sedgwick County <br />223 S Cedar <br />Julesburg, CO 80737 <br />Phone Number (970) 474-3576 <br />°~ ~". <br />~;~R-~ <br />Fax Number: (970) 474-3558 -...--~`'`~'~ <br />~ltl~ <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 />en losed. <br />Signature o Corporate O icer, Owner, or Designee <br />~-y- og <br />Date <br />M:~PERMIT1MASTERDOCUMENTS~M-AF-04 <br />