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ANNUAL FEE and REPORT REQUEST <br />R. E? ;.r <br />PERMITTEE NAME: Logan County z, V LD <br />PERMIT NO.: M-1993-069 D;,_, <br />k?n of ti <br />OPERATION NAME: Lindstrom Gravel Pit A?i'.ic?9n? v?lan <br />ANNIVERSARY DATE: November 26, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: 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 />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 your revised written annual report and annual report map 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 year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. 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: Kris Pennington <br />Permittee Name: Logan County <br />Address: 315 Main St., Ste. 2 <br />Sterling, CO 80751 <br />Phone Number: (970) 522-7879 <br />Fax Number: (970) 522-4018 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporat Officer, Owner, or Designee <br />/ 3 O ca° ?Ie<d <br />Date <br />M: PERMIT\MASTERD0CUNfNTS\M-AF-04 <br />