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,` '" <br /> <br /> ANNUAL FEE and REPORT RE QUEST REDF1vED <br />PERMITTEE NAME: Lincoln County MAY 01 1001 <br />PERMIT NO.: M-1999-043 Division otMineral <br /> s and GeoloBY <br />OPERATION NAME: C & D Farms No. 2 <br />ANNIVERSARY DATE: May 11, 2001 <br />ANNUAL FEE DUE: $225.00 (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 />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 your revised written annual report and annual report man to this form. Please Hole [hat oil <br />adequately labeled map thal clearly delineates and includes [he above elements may suffice for a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Yetc7tragerr <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Lincoln County <br />P.O. Box 39 <br />Hugo, CO 80821 <br />(719)743-2337 <br />(719)743-2815 <br />~t~~1 B CA k~ <br />If you have additional comments and/or information [ha[ 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 />Signature of Corporate Officer or Owner <br />off/ ~/a ~ <br />Dale <br />AI:~PERM ITMASTERDOCUM1fENTSUA-AF-Oa <br />