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a/C- <br />e.G S <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL F E nd REPORT REQUEST <br />gan County <br />V M. 1978-249 <br />Kokes Gravel Pit <br />RECEIVED <br />SEP 15 zoio <br />Dkis+on of ;-«:; ..,,,aticrr. <br />mk*g and SaFwty <br />October 1, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />Logan <br />--According-to--CR.S. 34-32,5-1-16_or_C-R.-S.-3.4-32..-116, each year,.-on?he anniversary date-of the 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: 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 ' form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />13 S zee r C) <br />Date <br />M: TERMITIMASTERDOCUMENTS\M-AF-04