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~/ <br />ANNiiAi. FF,F. and RF.P(1RT RF.nfiFST <br />RECEIVED <br />PERMITTEE NAME: Lincoln County NOV 0 3' ~3 <br />PERMTT NO.: M-1977-163-SG <br />Bisision ~f Minerals and Geology <br />OPERATION NAME: Fisher Pit <br />ANNIVERSARY DATE: November 21, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 [he year, if any. <br />Please attach ynnr revised wrifirn anneal re~nrt and anneal rennrt m ~n 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 />Hugo, CO 80821 <br />Fax Number: (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 />~~,~~.~_ <br />Signature of Corporate Officer, Owner, or Designee <br />!©-~~o <br />Date <br />M:\PE RMITUTASTER DOCUM ENTSVd-AF-04 <br />