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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Lincoln County <br />PERMIT NO.: M-1978-078 <br />OPERATION NAME: Pickenpaugh Gravel Pit <br />ANNPJERSARY DATE: May 24, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <br />--' -- According to C-.R:S.-34-325-1-16-orG:R~:-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 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 the year, if any. <br />Please attach vour revised written annual renort and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, renort, and <br />associated map. If no new disturbances or reclamation have occurred durinti the previous vear and no <br />new chanties to the previous year's map are necessary, then no new man is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />PermitteeContact: Don Blake Don Blake is no longer contact <br />PermitteeName: Lincoln County pegsba due"-to health problems. <br />Address: P.O. Box 39 <br />Phone Number: <br />Hugo, CO 80821 <br />(719)743-2337 <br />Fax Number: <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 />enclos~ed~ ~ ~ j <br />/f~//~. G!/CLi~I` O/L~m /1G~~~1? - ~i~/~L^~ <br />~gnature of C orate Offic r, Owner, or Designee <br />Dat~ ~~~ <br />M:~PERMINIASTERD000MEMSUI-AF-04 <br />