REP01858

• Permit No: M1987016
• IBM Index Class Name: Report
• Doc Date: 2/2/2001
• Doc Name: 110C ANNUAL FEE INVOICE AND REPORT REQUEST
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Lincoln County
M-1987-016
County Line Pit
,~pril 7, 2001
RECEIVED
APR 0 2 2001
~d
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Lincoln
According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of [he 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 yaur revised written annual resort and annual resort man to this form. Please Wore three an
adequately labeled map that clearly delineates rend includes the above elements mnv suffrce for n written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
PermitteeContact:.-PrrA-Aragon-• ~~ tJ (., KP.
Permittee Name:
Address:
Lincoln County
P.O. Box 39
Hugo, CO 80821
Phone Number: [phone]
Fax Number: [phone]
If }•ou 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
enclosed.
ignature of Corporate Officer or Owner
Date
M:~PERM ITVNASTERDOCUM ENTSUA ~AF~OA