REP46225

• Permit No: M1999043
• IBM Index Class Name: Report
• Doc Date: 5/3/2004
• Doc Name: 2004 Annual Report
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

Lincoln County
M-1999-043
C & D Farms No. 2
May 11, 2004

PERMTI'TEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:

MAY 0 3 2004
Division of Mi~tz;ah f'r G9o1eg4
$281.00 (Due on or before your anniversary date)
Lincoln
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an __
_ _ ~._ .operator shall-submit-the-annual-fee,-a-report-and map showing the extent of'cunerif disiuibances fo 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, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anm~al re~pnrt and annnal re nn rt maTtn this 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: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Phone Number:
Fax Number:
Hugo, CO 80821
[phone]
[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
enclos
d~~"crr/t--~
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMITN1ASrERDpUUMEN7SNI-AF-09