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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1984-185 <br />Ellis Allen Pit <br />February 28,2003 <br />RECEIVED <br />FEB 10 ?~3 <br />Qivision H Mlnerele and B~IoBY <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_ <br />_operator shall-submit the-annual-fee,-a=report-and-map-showing-the-extent of current-disturbances to-affected -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <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 your revised written anneal rennrt and anneal rennrt man to this form. p/ease note that an <br />adequately labeled map that clear/y delineates and includes the above elements may since 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: P.O. Box 39 <br />Phone Number: <br />Fax Number: <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 />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />0/- /h~o~ <br />Date <br />M:IPERMITMASTERDOCUMENTSU.I-AF-04 <br />