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)19 <br />2 "CEIVED <br />AAAL FiE and PORT REQUEST 10 t/ <br />DEC 16 2U <br />WW °' , <br />PERMITTEE NAME: Michael G. Erker and Cynthia L. Schmid tAdM 610 SS" 4-0 <br />PERMIT NO.: V'1-1985-200 <br />OPERATION NAME: Kula Gravel Pit <br />ANNIVERSARY DATE: December 18, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <br />According_to C.R.S. 34-3_2.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the -permit, 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 vour 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 chances 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: Cynthia L. Schmid <br />Permittee Name: Michael G. Erker and Cynthia L. Schmid <br />Address: 4803 Prairie Ridge Drive <br />Fort Collins, CO 80526 <br />Phone Number: (720) 363-9108 <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 <br />enclos ii. <br />of Corporate Officer, Owner, or Designee <br /> <br />Date <br />f -o Y.1, P et 5,Ch e,4_ Y-Cle-y-s rep t . Af Qcfivi?y <br />f , re pm <br />i S 0-LLrr0-K+ . <br />