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m? <br />F 7- <br />ANNUAL FEE and PORT REQUEST <br />Rec"D <br />PERMITTEE NAME: ?fincoln County JAN 0 5 <br />2olo <br />PERMIT NO. VM-2007-084 ?ivirion of kECI <br />Mining and ation, <br />OPERATION NAME: Clark Pit Safety <br />ANNIVERSAI Y DATE: January 7, 2010 <br />ANNUAL FEE DUE: $$323.00 (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 ? 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 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 recods indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth Morrison <br />I <br />Permittee Na e: Lincoln County <br />Address: 103 3rd Ave. <br />POBox39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: j (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 /> <br />SignAture of Corporate Officer, Owner, or Designee <br />Date <br />M:4E --ITIMASTERDOCUMENTS\M-AF-04