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s l` 1 ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Sedgwick County <br />/ M-1998-032 <br />Skold Pit <br />May 27, 2007 <br /> <br />._ <br />. ~ .' . ~ ~^ v n ~,>, <br />f...~ p <br />__ -. <br />$$281.00 (Due on or before your anniversary date) <br />Sedgwick <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 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 vour revised written annual report and annual report moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary. then no new moo is required, provided that the <br />Operator shall state this in the Annnal Resort. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written 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 St. <br />Julesburg, CO 80737 <br />Phone Number: <br />Fax Number: <br />(970)474-3576 <br />(970)474-3558 <br />mad- Q f1(? ~o 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 />encl ~~ . ~ ,,/ <br />/ ~ (~/'[/ <br />Sign ure of Corporate Officer, Owner, or Designee <br /> <br />Date <br />M:NERMINIASTERDOCUMENTSVN-AF-04 <br />