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<br />!r"rRPi <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Logan County <br />~M-1987-159 <br />Guenzi S & G Pit <br />December 28, 2005 <br />`/- ~S-OS <br />~~~ <br />fz~; /~~G <br />$688.00 (Due ou or before your anniversary date) <br />Logan <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 />-- -~- operatorshall-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 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,yonr revised written annual rePnrt and anm~al rennrt 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Byron Hickox <br />Logan County <br />315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />(970)522-0888 <br />(970} 522-4018 <br />l~ ~s~ ;~ ~ ~ ~~~~,~~ <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 />Signatur /orate Off^icer, Owner, or Designee <br />~~ / ~ Cam/ <br />Dafe <br />M;IPERMITNIASTERDOCUMENTSNI-AF-04 <br />