REP52671

• Permit No: M1999043
• IBM Index Class Name: Report
• Doc Date: 4/11/2002
• Doc Name: 2002 Annual Report
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lincoln County RECEIVED
M-1999-043
C & D Farms No. 2 PR' ~ ZQD2
t7ivision of Minerals and Gealo9Y
May 11, 2002
$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-] 16, 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 [o
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 vour revised written annual report and annual report map to 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: Don Blake
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. Annua] Report instructions are
enclosed.
Signaturelof Corporate Officer or Owner
®~10~~©Z
Date
M:~PERMnU1ASTERD000MENTSVN-AF-04