2002-02-01_REPORT - M1984185

• Permit No: M1984185
• IBM Index Class Name: Report
• Doc Date: 2/1/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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999
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Lincoln County
M-1984-185
Ellis Allen Pit
February 28,2002
RECEIVED
FEB 0 1 1002
~-
Division of Minerals and Geology
$281.00 (Due on or before your anniversary date)
Lincoln
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, 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 [hat 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 [he year, if any.
Please attach your revised written annual report and annual report map to this form. Please core that au
ndegirutely labeled reap that clearly delineates and includes the above elements rnny since for a lrritten
report.
Division records indicate [he following pennittee contact information. Please verify and make any necessary
changes:
PetTnittee Contact: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Phone Number
Fax Number:
Hugo. CO 80821
(719) 743-23.7
[phone]
If you have additional comments and/or information that should be provided to [he Division, please provide it
below or attach it [o [his form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer or Owner
of-,1~- o Z
Date
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