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ANNUAL FEE and REPORT REQUEST <br />PERMIT"TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-2000-048 <br />Schmidt Gravel Pit <br />August 28, 2002 <br />RECE-VED <br />aus o ~:~0z <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Kiowa <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 />land, reclamation accomplished to date and during the preceding year, new disturbances [hat 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 [he year, if any. <br />Please attach your revised written annual resort and annual resort map to this form. Please note that an <br />adegaately 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 />PernTitteeContact A4iIEe-Sifter R~cha,rd McOartt;el. <br />Permittee Name: Kiowa County <br />Address: 1305 Goff St. <br />P.O. &~x -oo <br />Eads, CO 81036 <br />Phone Number: <br />Fax Number: <br />(719)438-5810 <br />(719)438-5327 <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 />~~~~ ~~ <br />Signature of Corporate Officer or Owner <br />~)~~lo~ <br />Dater <br />MIPERMITMASTERDOCUMENTSU4-Ar-04 <br />