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fmw <br />~~~'~hpS <br />~~~ - -- <br />AUG 0 12005 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1985-105 <br />Harold Eichman Gravel Pit <br />August 6, 2005 <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <br /> <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 />opera shall°submirthe-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 distiirtiarices'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 />PI as .attach ymir revised written anmial re~nrf and anm~al re~nrf maP to fhic form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 />T~~ C <br />Signature of Corporate Officer, Owner, or Designee <br />'~] ~ p t~~ <br />Date <br />M:IPERMITNfASTERDOCUMENTSN-I-AF-04 <br />