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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />(j ANNUAL FEE and REPORT REQUEST <br />Lincoln County <br />M-2004-001 <br />Lofdahl <br />February 13,2007 <br />RECEIVED <br />~FEB 0 y 2007 <br />vision of rieciamauon, <br />Mining and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Lincoln <br />oz'dt-d1 <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 sfiall submit the annual -fee, a report and map showm`g Yfie extent of'current di`sturbahces to affecf'd- <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 man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated maa. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanees 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719)743-2337 <br />(719)743-2815 <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 aze <br />enclo//s/~e//d~~. ~~-- <br />l/~Lili//~L/ -~~lOii~~,. Gs~~ L~~LCm~. , <br />Signature of Co ate Officer, Owner, or Designee <br />.--- <br />G <br />Date <br />M:~PERMITMAS7ERDOCUMEMSVN-AF-04 <br />