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<br />RECEIVE <br />JUL 0 3 2003 <br />Division rf Minerals and Geslony <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />M-1999-029 <br />Bob Terrill Clay Pit <br />June 22, 2003 <br />$281.00 (Due on or before your anniversary date) <br />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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />--lands 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 annnal ren^rt and anm~al re nn rt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: --I£crt-Shottsotr' <br />Permittee Name: <br />Address: <br />_ PhoneNumber: <br />Fax Number: <br />Logan County <br />31 S Main St. <br />Sterling, CO 80751 <br />(970)522-0888 ___ __ __ .- <br />(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. g,~l . 2i ~ Jp3~~ <br />.6'~~ 1J• <br />Signa e of Corporate Officer, caner, or Designee <br />~/ao/ 3 <br />Date ~ <br />M 9PERMITU1ASTERD000M ENTSVN-AF-04 <br />