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M~ <br />.t„ <br />/~ <br />V ANNIIAL FF,F and RF.PnRT RF.OiiF.ST <br />RE~ESVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Lincoln County <br />M-1984-185 <br />Ellis Allen Pit <br />February 28, 2006 <br />FEB 0 2 2006 <br />vision of Minerals and Geology <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-sub'mit the-annual fee; a ?epor~ and-m`ap-sfiowing the~extenY of c,urren"f-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 Ynnr revised written annual re,~Qrt and anmial re~nrt man M this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufftce 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: <br />Address: <br />Lincoln County <br />P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: (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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:NERM171MASTERD000MENTSN3-AF-0q <br />