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<br />ANNUAL FEE and REPORT REQUEST <br />I ~' <br />RECEf VE® <br />PERMITI'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-1983-112 <br />Murdock Gravel Pit <br />August 25, 2002 <br />AUG 0 1 2002 <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-i16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operafoc 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 yeaz, new disturbances that are anticipated to <br />occur during the upcoming yeaz, 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 yeaz, if any. <br />Please attach vour revised written annual report and annual resort map 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 pemuttee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard McDaniel <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Kiowa County <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719)438-5810 <br />(719) 438-5327 <br />L` 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 />I.PiGL/ <br />Signature of rporate Officer or Owner <br />~1~~- <br />Date <br />M: (PERM771MASTERD000MEN7541~-AF-00 <br />