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<br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />David A. Lincoln <br />M-2001-038 <br />Bennett Sand & Gravel Pit #2 <br />August 6, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />JUl 2 4 2002 <br />Division of Minerals and Gaologtl <br />According to C.R.S, 34-32.5-1 ] 6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />___~hall_submit..the-annual fee,-a-report--and-map showing the extent of-current disturbances to affected land; - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may s~ce for a wrinen report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David A. Lincoln <br />Permittee Name: David A. Lincoln <br />Address: 5599-)/-5. <br />50500E 72u-D ~v~ . <br />3Gt~tt~tETC ~. $otoZ <br />2 <br />Phane Number: {383}-833-903' 3©3-!o'~c{ -3030 <br />Fax Number: f393j-853~H83 303-(o~{~-cF7cl3 <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 enclosed.- <br />~ G ~~r~s ~ Na`~ <br />Signature of Corporate Officer or Owner `- <br />v\ <br />7-I ~-©2 <br />Date <br />C'BS G f}+-~ ~C <br />M1PERM17U7 ASTERDOCUMENTSN7-AF-OI <br />