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• iii iuiiiiiniii iii • <br />ANNUAL REPORT <br />PERMITTEE NAME: Lincoln County <br />PERMIT NO.: M-SS-105 <br />OPERATION NAME: Harold Eichman Grav <br />ANNIVERSARY DATE: August 06, 1999 <br />J~~ <br />P~G~ ~~~'~~~~~ <br />P~~' 0 sg~a~~ <br />o~~ <br />dos` <br />o~.c <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Lincoln <br /> <br /> <br />ago` <br />According to C.R.S. 34-32-1 l6(3)(a), each yeaz, on the anniversary date of the pertmit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished [o date and during the preceding year, hew <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report tp this <br />atlnual report. Please note that nn adequately labeled mnp that c[enrly de[inedtes and <br />includes the nbove elements mny suffice for n written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Pete Aragon <br />Address: P.O. Box 39 <br />Com an Lincoln County <br />P Y~ <br />Phone No.: (719 1743-2337 <br />Fax No.: (719 1743-2815 <br />If there are additional comments and/or information that should be provided [o the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Sig ati~ure of Corpor3f Officer, or Owner ate <br /> <br />INSTRUCTIONS ON BACK <br />