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<br />RECEIVED <br />APR 0 12003 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1987-016 <br />County Line Pit <br />April 7, 2003 <br />Division 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 submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, ieclamaiion`accompli"shed [o date-and during the preceding year, new dist`ur6ances [fiat are anticipa[ed to -` <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dales for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ym~r revised written annnal report and annnal rennrt ma+ in this form. please note that an <br />adequately labeled map that clearly dellneares 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 />~~~ <br /> <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 />~3 ~ r2 ~n > <br />Date <br />M:~PERMITU.f ASTERDOCUM ENTSVv1-AF-04 <br />