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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1978-078-SG <br />George Ansley Pit <br />May 24, 2003 <br />RECEIVED <br />MAY 0 1 2003 <br />Division of Minerals and Geology <br />$281.00 (Due on or beTore your anniversary date) <br />Lincoln <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual report and annnal report manrtn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: P O Box 39 <br />Hugo, CO 8082] <br />Phone Number: <E7-1-9j-743.35-13--- '~7 i ~ - ~ u ~- X33'7 <br />Fax Number: q~~83$- ~ i 9 - 7',~3 - X81 ~ <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 />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />o~/,~ to <br />Date <br />M:~PERMITMASTERD000MENTSUI-AF-04 <br />