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..'~ <br />e~^~' <br />~J~,,hhp <br /> <br />JUL 19 2005 <br />®iVlaian of Poiinercl~ & Geology <br />PERMITTEE NAME: Kiowa County <br />PERMIT NO.: M-2000-048 <br />OPERATION NAME: Schmidt Gravel Pit <br />ANNIVERSARY DATE: August 28, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: ICiowa <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-te-date-and-during-the precedingyear,-new-disiurbances 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 ynnr revised written anneal rennrt and anneal re~nrt map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: u.:d,o a *~ n ~ Re~.~.~, <br />Permittee Name: Kiowa County <br />Address: CF.PR.address 1 <br />P.O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719)438-5810 <br />(719)438-5327 <br />~lt~ ,Ceremon - ~/lee CJ. LJa l'Tj <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 />Si ature of Corporate Officer, Owner, or Designee <br />- /3 -oS <br />Date <br />M:~PERMITMASTERDOCUMENTS~M-AF-09 <br />