2008-06-12_REPORT - M1986074 - Laserfiche WebLink

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ANNUAL FEE and FPORT REOUEST PERMITTEE NAME: Kym A. Schure PERMIT NO.: M-1986-074 ?'/ OPERATION NAME: Dollerschell Pit ECEWED JUN 1 2 2008 Division or kedamation, Kning and Safety ANNIVERSARY DATE: June 30, 2008 ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) COUNTY: Logan 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. riease attach your revised written annual report and annual report map to this form The Annual Report &-Fee-requirement -is not-met until we have received the following components: fee, report, and associated man. If no new disturbances or reclamation have occurred durine the previous year and no new chanLres to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Kym A. Schure Permittee Name Address Phone Number: Fax Number: Kym A. Schure 12826 CR 37 Sterling, CO 80751 (970) 522-9485 If you have additional comments. and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. i Sign re of Corporate Officer, Owner, or Designee Date