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ANNI7AL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE ANNUAL FEE DUE: COUNTY: Lincoln County M-1978-051 Gaede Pit May 24, 2007 $$281.00 (Due on or before your anniversary date) Lincoln - -According-to C:R:S-34=32.5=116-or C:R:S: 34=32-1-16,-each-year,-on the anniversary-date-of the permit,-an - operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual report and annual renort man to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, renort, and associated man. If no new disturbances or reclamation have occurred during the urevious year and no new changes to the nrevious year's map are necessary, then no new map is required, urovided that the Ouerator shall state this in the Annual Reuort. Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following pemuttee contact information. Please verify and make any necessary changes: PermitteeContact: Don Blake Don Blake is no longer contact PennitteeName: Lincoln County person due to health problems. Address: P.O. Box 39 Hugo, CO 80821 Phone Number: (719) 743-2337 Fax Number: (719) 743-2815 If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclose /J q p , ignature of Co rate Officer, caner, or Designee c 2 ~ D M:IPERMIIIMASTERDOCUMENTS~M-AF-04