2006-08-16_REPORT - M1997061

• Permit No: M1997061
• IBM Index Class Name: Report
• Doc Date: 8/16/2006
• Doc Name: Annual Fee/Report/Map
• From: Sedgwick County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

i
ANNUAL FEE and REPORT REQUEST
RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Sedgwick Couuty
M-1997-061
ICinnie Gravel Pit
September 5, 2006
AUG 7 6 2006
Division of Reclamation,
Mining and Safety
$281.00 (Due on or before your anniversary date)
Sedgwick
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual reuort and annual report mau to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Randy Renquist
Permittee Name: Sedgwick County
Address: 223 S. Cedar
Julesburg, CO 80737
Phone Number: [phone]
Fax Number: [phone]
~d~'T
5~~~
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
~~~
Si ~ ture of Corporate Officer, Owner, or Designee
Date
M:\PERM ITNIASTERDOCUMENTS\M-AF-04