REP47054

• Permit No: M1978078
• 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

F-
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
RECE-~E®
MAY 0 3 2004

Division of Minsrsis & Oeelei'1
Lincoln County
M-1978-078
Pickenpaugh Gravel Pit
May 24, 2004
$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 year, on the anniversary date of the permit, an
operator shall submit the annual fee, a report and map showing the extent 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, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynLr revised written anmral re~nrt and annnal re n m fn 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: •-Pete-r4ragew~ ~ ~rsrJ L~CR kC
Permittee Name: Lincoln County
Address: P.O. Box 39
Hugo, CO 80821
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 Cor//porate Officer, Owner, or Designee
Date
M:~PERMI7 Vv1A5TERD000M ENTSUI-AF-06