2005-08-17_REPORT - M2000066

• Permit No: M2000066
• IBM Index Class Name: Report
• Doc Date: 8/17/2005
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DMG
• Media Type: D
• Archive: No

15-eUG-2005 12:dd F6'OM-Colorado Division of Mlinerals Z Gsolcay
PERMTI-f E5 NA1~lE:
PERMIT NO.
OPERATION NAME:
A:ti'NIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
X13036323106
T-3d0 P.002/002 F-714
Lincoln County
M-2000-066
llaymond Ersdersou Fit
July 12,2005
$281.00 (llae on or before your anniversary date)
Lincoln
Act:ording to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each Year, on the atmivcraary' date of the permit, an
operator shall submit the annual fcq a report and map showing the extent of current disturbances to affected
lard, zeclatnation accomplished to date and during the preceding year, rew disttabances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates For the
beginning of acpve operations, and fhe date active opttations ceased for the year, if any.
Pl co attach vns r revi eA written annreal ennrt and annual n+lyorr man to this,fprJrs, PI¢ase nof¢ t/ta: an
adequately labeled rnap that clearly delineates and includes the above ele»terrts may since for a written
,•eport.
Divisior, Yeeords indicate the following pernittee contact information. Please verify and make any necessary
changes:
Pctmittee Contact: Don Blake
Permituc Name: Lincoln County
Address: P.O. Box 39
Phone Number
Fax Number:
Hugo, CO 80821
(7I9) 743-2337
[phone]
[f you have additional comments and/or information that should be provided zo the Division, please provide if
below or attach it to this form along with your written repot and ntap. Annual Report insrcuctions an
a~ttcl d.
Signature of Corporate Officer, Owner, ar Designee
L.(~~~~
Lla[c
M •W F]L\f ITdAnSTfROCCUNFNTSUI.AFAa