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<br />RECEl~~4 e; <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1978-072 <br />Brent Pit <br />May 24, 2003 <br />MAY 0 1 ~~~~ <br />Division of Minerals an;: G;;Icpq <br />$281.00 (Due on or before your anniversary date) <br />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 I <br />opera or sfiall`submit'the annual fee,-a report-and'map`showing'the-extentrof-current disturbances-to-affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to I <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 xQur revised written anm~al rennrt and annual re ran t map_tn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: <br />Phone Number: <br />Fax Number: <br />P.O. Box 39 <br />Hugo, CO 80821 <br />(719) 743-2337 <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 />enclosed. <br />~~ Q <br />Signatu//re of C//orporate Officer, Owner, or Designee <br />Dafe <br />M:~PERMITUTASTEADOCUMENTSVd-AF-04 <br />