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//Y <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUA and e O T REQUEST <br />1 ?, ,ogan County <br />978-249 <br />Kokes Gravel Pit <br />October 1, 2008 <br />o/C <br />f7 S <br />P 2 2008 <br />D""8.on C., i,eclamation, <br />/ _ Mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />Logan <br />______Accord ng- o_C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator-shall-submit-theannual- fee, a- report-and map-sliowing=the-extent-of--current isturbances to-affectedl-- _ _ __-_ <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 necessarv <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />?S P n <br />!SR ?0 *A <br />Phone Number: (970) 522-7879 <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 atta h it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Sign re of Corporate icer, Owner, or Designee <br />/o '-5?e '069 <br />Date <br />M:IPERMITq%4ASTERDOCUMENTS\A4-AF-04