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(0/< <br />ANPOAL FEE &RIPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: Logan County <br />/MAY 2 n 2009 <br />PERMIT NO.: /M-1999-029 <br />;.,ectamation, <br />OPERATION NAME: Bob Terrill Clay Pit Division <br />no oe rarl jamatr <br />ANNIVERSARY DATE: June 22, 2009 <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 th_e_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: Dustin-M ;-- <br />Permittee Name: <br />Address: <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: <br />Fax Number: <br />If you have additi <br />below or attach <br />enclosed. ? <br />(970) 522-4018 <br />6 i 5 I C?? J? <br />X40 5 ---1 cA -9 <br />and/or information that should be provided to the Division, please provide it <br />,along with your written report and map. Annual Report instructions are <br />of <br />Owner, or Designee <br />lS o <br />Date <br />M-\PERMITMASTERDOCUMENTS\N4-AF-04