2006-07-12_REPORT - M1985109

• Permit No: M1985109
• IBM Index Class Name: Report
• Doc Date: 7/12/2006
• Doc Name: Annual Fee/Report/Map
• From: DMG
• To: Lincoln County
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
t/ANNUAL FEE and REPORT REQUEST
// Lincoln County
r/ M-1985-109
Arthur L Schmeiser
August 6, 2006
RECE6'~JE®
~~ ~~UL 12 2006
~ Division of Minerals anti veck:gy
$281.00 (Due on or before your anniversary date)
Lincoln
l~SIL
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
operator shalLsubmit_the.annual_fee,_a_report and map showing the extent of_current disturbances to affected _-
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following pennittee contact informafion. Please verify and make any necessary
changes:
Permittee Contact: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Phone Number:
Fax Number:
Hugo, CO 80821
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMITNOASTERD000MENTSM-AFRO