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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME; <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-]978-078 <br />Pickenpaugh Gravel Pit <br />May 24, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <br />RECEI V Ep <br />MAY 0 1 2003 <br />Division of Minerals and Geology <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 />oper- atoi shall sulimit tfie annual fe`e-a ieporYand'map-showing-the-extent•ofcurrent-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 yeaz, if any. <br />Please attach ~ nor revised written anm~al renort and anm~al renort man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since jor a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Pete Aragon <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 are <br />enclo ed. <br />Signa a of Corporate Officer, Owner, or Designee <br />yea /~.~ <br />Date <br />M iPEAM ITUTASTE R DOCUM ENTSVv1-A F-04 <br />