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r <br />/0 r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Schuler Construction <br />t?4 2005-002 <br />Schuler Construction Pit # 1 <br />June 24, 2010 <br />)0?1 <br />CI'VED <br />`LCi` <br />JUN 2 :? ? 1 <br />Dlvlslon of &eda matlM <br />Nitntng <br />$$323.00 (Due on or before your anniversary date) <br />El Paso <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 />--- reciamati-an-acco;uplisl;ed-is-date and-during-the preceding-year, rrew-disturbarreeg thaiare-anti-cipatied'-ta o ur--during the upcoming year, reclamation that will be performed <br /> during the coming year, the dates for the beginning <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 chanzes to <br />the previous year's map are necessary, 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: Dave Schuler <br />Permittee Name: Schuler Construction (?i??.U <br />Address: 4520 Ramah Highway <br />Yoder, CO 80864 ?U g <br />Phone Number: (719) 478-2442 7 9 <br />Fax Number: <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 enclose"d.? <br />r <br />S nature of Corporate Officer, Owner, or Designee <br />-6 :::?-ID <br />Date <br />i