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<br /> <br />r <br />III IIIIIIIIIIIII III <br /> 999 <br />~~o <br />~4. ~, ~~ <br />G °`° <br />PERMITT~ NAME°~ <br />J~ <br />PERMIT NO.:,~,•' <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Phillips County <br />M-1989-095 <br />Schneller Clay Pit <br />November 27, 2001 <br />RECEIVED <br />JAN 0 8 200 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Phillips <br />/f <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-shawing'the ezten[ of_curren[ dis["ur ab noes to affected <br />land, reclamation accomplished to dale 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 your revised written annual report and annual report map to this form. Please Wore that an <br />ndequntely Inbeled rnnp that clearly delbreates and blchtdes the above elements rnap suffice for n written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact <br />Pertrtittee Name: <br />Address: <br />Randy Schafer <br />Phillips County <br />221 S.Interocean <br />Holyoke, CO 80734 <br />Phone Number: (970) 854-3778 <br />Fax Number: (970) 854-381 I <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signa[ur f Corporal Officer or Owner <br />io~~~~~ <br />Dale <br />ANNUAL FEE and REPORT REQUEST <br />AI:IPERM INIASTERDDCUM ENTSNI-AF-P1 <br />