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`~-s <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />J/~ AATNi1A1, FF.F, and REPORT RF.t7iTF,ST <br />`/ Sedgwick County <br />// M-1998-032 <br />Skold Pit <br />May 27, 2006 <br />RECEdVED <br />MAY 0 5 2006 <br />Division of Minerals end Geology <br />$281.00 (Due on or before your anniversary date) <br />Sedgwick <br />/Vtb~ <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 />-tand,-rzclamation aecomplished'to`date'andzluring-the preceding year; new-disturbances that are anticipated"fo ' <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 ynnr revised written annnal rennrt and annual report m,~ to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Randy Renquist ~ t~4-- ..Q vIe(0 g $ <br />Permittee Name: Sedgwick County <br />Address: 223 S. Cedar St. <br /> Julesburg, CO 80737 <br />Phone Number: (970) 474-3576 <br />Fax Number: (970) 474-3558 <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. <br />s <br />Signature o orporate O facer, caner, or Designee <br />©~1~~0~ <br />Date <br />M:\PERMITUTASTERDOCUMENTS4M-AF-04 <br />