2005-07-11_REPORT - M2001038

• Permit No: M2001038
• IBM Index Class Name: Report
• Doc Date: 7/11/2005
• Doc Name: Annual Fee/Report/Map
• From: david a lincoln
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNiTAi, FF.F. and RF.P(7RTRF,Ofi~ r~li~~'~~®
David A. Lincoln
M-2001-038 Division of Mineral;t and Geology
Bennett Sand & Gravel Pit #2
August 6, 2005 ~, ~ _ __Y _._. ^
$688.00 (Due on or before your anniversary date)
Adams
JUL 1 1 2005
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
shall submit-the-annual-fee,,-a-report-and-map showing-the-exterit-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, thc; dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ymrr revised written annnal re,Pnrt and annnal re nrt m P to Chic form, Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: David A. Lincoln
Permittee Name: David A. Lincoln
Address: 50500 E. 72nd Ave.
Bennett, CO 80102
Phone Number: [phone] _
Fax Number: [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
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Date