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I <br />AN AL? FEE and REPORT REQUEST <br />?r ? ,, ?? 1000 <br />a?oa9 <br />PERMITTEE NAME: Lincoln County Ked <br />?aww <br />PERMIT NO.: "M-2002-108 a?Xa <br />M; <br />OPERATION NAME: Eikermann <br />ANNIVERSARY DATE: October 29, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <br />-According_to_C.R.S. 3_4-32.5.-116_or_C.R.S._34z32=11.6,_each_y_ear, on_the-anniver.sar_y_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, 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous Year and no <br />new changes to the previous year's map are necessary, then no new map is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -Pon-Blake- <br />Permittee Name: Lincoln County <br />Address: <br />Phone Number: <br />P.O. Box 39 <br />Hugo, CO 80821 <br />(719) 743-2337 <br />Fax Number: (719) 743-2815 <br />Kenneth Morrison <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 />w(J <br />Sign ture of Corporate Officer, Owner, or Designee <br />September 8, 2008 <br />Date <br />M:\PERMITIMASTERDOCUMENTSUAI-AF-04