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ox- <br />V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANJAL FEE and CI-PORT REQUEST <br />A Lincoln County <br />?M-2007-084 <br />Clark Pit <br />January 7, 2009 <br />?JQc <br />RISC 12? F ISi? 11 <br />/OEC 10 Z0063 <br />Division .: o!a-nation, <br />Mining and Safi ?Y <br />71 $$323.00 (Due on or before your anniversary date) <br /> <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, 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 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 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: Kenneth Morrison <br />Permittee Name: Lincoln County <br />Address: 103 3rd Avenue <br />POBox39 <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 />Sig ture of Corporate Officer, Owner, or Designee <br />-0cC-. 5 ?--0 O <br />Date <br />M: \PERMI T1MAS TERDOCUMENTS\N4-AF-04