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<br /> ANNUAL FEE and REPORT RE VEST <br /> APR 2 ~ Z008 (/ <br />PERMTTTEE NAME: Clyde and Marie Couch Blttfsrc~n a. Keclernation <br /> <br />PERMIT NO.: <br />M-1989-023 ~~ , <br />Rfli~ing and Safety c./ <br />OPERATION NAME: Caliche School Pit <br />ANNIVERSARY DATE: March 9, 2008 <br />ANNUAL FEE DUE: $$323.00 (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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />- - reclamation-accomplished-t~ date and-~iuririg the preceding year, new disturbances that are anticipated fo 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 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 vear and no new chanEes to <br />the previous year's map are necessary. then no new map is reauired, 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 />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 />Permittee Contact: Ben Winemiller ~~ <br />Permittee Name: Clyde and Marie Cou <br />Address: 122 State St. <br />Sterling, CO 80751 <br />Phone Number: (970) 522-1239 <br />Fax Number: <br />Signa re of Corporate Officer, Owner, or Designee <br />=~?~-dam <br />Date <br />