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ecs <br />A A FEE and P RT REQUEST <br />PERMITTEE NAME: Nienhueser Construction & Excavating Co AA,,?? RECEIVED <br />PERMIT NO.: x/141-2001-018 1 AR 2 2 2010 <br />OPERATION NAME: Schumacher II Division of Reclamation, <br />Mining & Safety <br />ANNIVERSARY DATE: April 19, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Logan <br />po K <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />wring the upcoming year,-reclaination tiat wil 1715 e performed wring the coming year, the dates for the beginnirig <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Keith Nienhueser <br />Permittee Name: Nienhueser Construction & Excavating Co <br />Address: 1500 10th Ave. <br />P.O. Box 173 <br />Phone Number: <br />Fax Number: <br />Sidney, NE 69162 <br />(308) 254-3453 <br />(303) 254-3455 <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />??le ! Q <br />Date