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~~~ <br />-Q~~ <br />1/ ANNUAL FEE and REPORT REQUEST <br /> ~ R <br />ECEIVED <br />PERMITTEENAME: SedgwickCounty <br />/ / <br />} 6 ZOO6 <br />PERMIT NO <br />: M-1997-061 ' AUG <br />. <br />OPERATION NAME: IZinnie Gravel Pit VDivision of Reclamation, <br /> Mining and Safety <br />ANNIVERSARY DATE: September 5, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Sedgwick <br />According-to-~.R:S.-34-32.5-116 or C.R:S-34-32-?16,=ea:.h year;-on-the anniversary dates of-the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />]and, reclamation accomplished to date and during the preceding year, new disturbances 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 vour revised written annual report and annual report mao 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 <br />Permittee Name: Sedgwick County <br />Address: 223 S. Cedar <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 />Si •e o orpora e Officer, O er, or Designee <br />m~ -off _ 06 <br />Date <br />M:IPERM771MASTERD000M ENTSIM-AF-04 <br />