2006-05-02_REPORT - M1978078SG

• Permit No: M1978078SG
• IBM Index Class Name: Report
• Doc Date: 5/2/2006
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
i/' ANNiiAT. FF.E and REPORT RF.nTTF.ST
Lincoln County
M-1978-078-SG
George Ansley Pit
May 24, 2006
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`~ MAY Q 22006
~Oiu{doa of MinarehaodGaalegr
$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-thahare 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 ypur revised written annual rennrt and anm~al reForf m n this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Petmittee Contact: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Phone Number:
Fax Number:
Hugo, CO 80821
[phone]
[phone]
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
enclosed.
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Signature of Corporate Officer, Owner, or Designee
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Date
M:V'EAMI7IMASTERDOCUM ENTSN-I-AF-04