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,If ?' r " It " ANNUAL FEE and REPO AT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />i Logan County <br />I,AvI-1978-146 <br />Stephens Pit <br />October 1, 2008 <br />f-5 A <br />RE I,= ,, <br />_ CC ? `?:E U <br />ee l 2 2008 <br />Division o? meciarnation, <br />-/;W? ng and Safety <br />$791.00 (Due on or before your anniversary date) <br />Logan <br />_ - _ According_to_C.R.S._34-32.5=1.1.6 or_C.R.S._34-32-116,_ each-yea-r,-on-the anniversary date_ of_the,_permit, an_ _ __ _ _ _ - <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 your revised written annual report and annual report map 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 required, 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 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: Kris Pennington <br />Permittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: - <br />Fax Number: (970) 522-4018 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a c it tot ? form along with your written report and map. Annual Report instructions are <br />enclose . <br />S'gnature of orporate O icer, Owner, or Designee <br />/ 0 "?r'e Zd0 9 <br />Date <br />M. \PERMIIIMAS TERDOCUMENTS\A4-AF-04