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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/ OLogan County <br />/ M-1999-029 <br />Bob Terrill Clay Pit <br />June 22, 2010 <br />mcow" <br />'1 MAY 'L 4 2010 <br />Divisien of Races, <br />t% Ltning Rnd SO* <br />$$323.00 (Due on or before your anniversary date) <br />Logan <br />- s to--C.RS. 34-3Z.5-1-..t6-.or R S._3^- 2 11 .each- Par, orl th ?mn»e arm date c,f tl?? nom,.,, t ara n . <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 reauired, 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: (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 attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Iq '164 <br />Date <br />M:IPERMITIMAS TERDOCUMENTSM-AF-04