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r? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNIf ?ALFIE and REPORT REOUEST <br />Sedgwick County <br />1/M-1997-061 <br />Kinnie Gravel Pit <br />September 5, 2009 <br />eCS ot<:Z- <br />RECEIVED <br />AUG 1 7nnq <br />Division of FZ)edarnaticn, <br />7U Mining End ? Ar <br />$$323.00 (Due on or before your anniversary date) <br />Sedgwick <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 <br />operator shall -submit the annual fee,_ a repprt 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 <br />Permittee Name <br />Address <br />Randy Renquist <br />Sedgwick County <br />223 S Cedar <br />Julesburg, CO 80737 <br />Phone Number: (970) 474-3576 <br />Fax Number: (970) 474-3558 <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 <br />enclo <br />Signature of Co orate Offic , wner, or Designee <br />S? o " _"Z <br />Date <br />M:IPERMIT\MAS TERDOCUMENTS\M-AF-04