REP16666

• Permit No: M1985109
• IBM Index Class Name: Report
• Doc Date: 8/1/2003
• Doc Name: Annual Fee/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lincoln County
M-1985-109
Arthur L Schmeiser
August 6, 2003
RECEIVED
AUG 0 1 2003
Division ~f 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 exfent of curFent disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that 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 the year, if any.
Please attach nor revised written annual rennet and anmral rennet m ~n to this form. Please note 1ha1 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:
Permittee Contact: Don Blake
Permittee Name: Lincoln County
Address:
Phone Number:
Fax Number:
P.O. Box 39
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.
~~~ ~}~
Signature of Corporate Officer, Owner, or Designee
o~/ZI ~~3
Date
M.~IPERMITIMASTERDOCUMENTSUf-AF-04