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mR c <br />r #7- <br />ANNUAL FEE and REPORT REQUEST <br />'ICT ? v 200 <br />PERMITTEE NAME: Lincoln County -f? Mining ar;c; Saiety <br />PERMIT NO.: 'M-1977-163-SG <br />OPERATION NAME: Fisher Pit <br />ANNIVERSARY DATE: November 21, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: 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 -submitthe, 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 vour revised written annual report and annual reuort man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessarv, then no new man is reauired, arovided 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 />PermitteeContact: =D_orrBlake-- Kenneth Morrison <br />Permittee Name: <br />Lincoln County <br />Address: <br />Phone Number <br />Fax Number: <br />P.O. Box 39 <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 />Signature of Corporate Officer, Owner, or Designee <br />O-etober 3, 2008 <br />Date <br />M:\PERMITIMASTERDOCUMENTS'M-AF-04