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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ANNTiAT, FF.F, and RF.PTTRT RF,nTTF.ST <br />~ Lincoln County <br />~~ M-1978-078 <br />Pickenpaugh Gravel Pit <br />May 24, 2006 <br />RECEIVED <br />~INAY U 2 2Q06 <br />~ivisiao of Minerals and Geology <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.accomplishedao_date_and during_ihe_preceding-years 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~rr revised written annnal rennrt and annual rennrt man to 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: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719)'743-2337 <br />(719) 743-2815 <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 />l1V~ <br />Signature of Corporate Officer, Owner, or Designee <br />o~-ln~n b <br />Date <br />M:~PERMI'[~MAS7ERDOCUMENTSIM-AF-04 <br />