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PERMITTEE NAME: C C Jeffrey L. Schumacher <br />`j G Division of Reclamation, <br />PERMIT NO.: M- 2006 -072 Mining & Safety <br />OPERATION NAME: Schumacher Pit #3 <br />ANNIVERSARY DATE: March 5, 2012 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Logan <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 />during the upcoming year, reclamation that will be performed 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 changes 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 />�! $ <br />ye it c/I /id <br />e m ; yew sys lert <br />changes: <br />Permittee Contact: Jeffrey L. Schumacher <br />Permittee Name: <br />Address: <br />Fax Number: <br />Jeffrey L. Schumacher <br />a31 <br />Sterling, CO 80751 <br />Phone 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 enclosed. <br />Ale lt/a„✓ /AS 4(446..( c e5 or ree4.o.st a-pt <br />1. 0 cc (14tc 7 ,�11I'U4- <br />1 GC11-4 <br />na / re of Corporate Officer, Owner, or Designee <br />02 - <br />Date <br />ANNUAL FEE and REPORT REQUEST <br />NAK <br />rg751 cR .37. <br />� Clio) 5.zo - 5 o d'3 <br />RECEIVED <br />V FE.B <br />