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7'~ ~ ~- ~~ <br /> ANNUAL FEE and REPORT REQUEST L <br />1Q <br /> / <br />l <br />PERMTTTEE NAME: Nienhueser Construction & Excavating Co Y <br />PERMIT NO.: M-2001-018 <br />OPERATION NAME: Schumacher II <br />ANNIVERSARY DATE: Apri119, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Logan <br /> <br />APR 16 2008 ~ <br />t7ivision of ~teclamation,~ <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 />- - -- - '__ =durirrg tire-upcoming`year; reclamation"thaw will lie performed-~unng the coming year, tie 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 Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Keith Nienhueser <br />Permittee Name: Nienhueser Construction & Excavating Co <br />Address: 1500 10th Ave. <br />P.O. Box 173 <br />Sidney, NE 69162 <br />Phone Number: (308) 254-3453 <br />Fax Number: (303) 254-3455 <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 />%f -- /~/ -DR' <br />Date <br />