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<br />FiEC~I\/~D <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-2002-108 <br />Eikermann <br />October 29, 2003 <br />OCT 0 72003 <br />Division of Minerals and GeeloAY <br />$281,00 (Due on or before your anniversary date) <br />Lincoln <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land,-reclamation accomph`shed-gate and dunng t e prece mg year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach Ynur revised written annual report and annnal re,Pnrt m ~n fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719) 743-2337 <br />(719)743-2815 <br />~'o , C-~~,c 3 ~ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~/\ ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />0`3~ /D~~ <br />Date <br />M:IPERMn1MA$TERD000MENTSV.1-AF-04 <br />