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<br /> A <br />S <br /> A FEE a El <br />T RE UE <br />T <br />RECEIVED <br />PERMITTEE NAME: 'n) Nienhueser Construction & Excavating Co <br />MA <br />011 <br />PERMIT NO.: yM-2001-018 R 10 2 <br />OPERATION NAME: Schumacher II Division of Reciamatm, <br />-0 Mining & Safety <br />ANNIVERSARY DATE: April 19, 2011 <br />ANNUAL FEE DUE: $$323.00 (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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />---during-thP upa.om?n Par YPC?A, 1Y1- A? t? n that will be performed during the coming yea.-, the.dates for the beginning <br />?? _- <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's man are necessarv, then no new man is reauired, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Keith Nienhueser <br />Permittee Name: Nienhueser Construction & Excavating Co <br />Address: 1-5,96-i0+1t Ave. /.2513 Rp )l3 <br />P.O. Box 173 RA B4yc 173 <br />Sidney. NE 69162 <br />Phone Number: (308) 254-3453 <br />Fax Number: (303) 254-3455 <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />.3- 7- <br />Date