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`/.X <br />vl_'? , <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />? Lincoln County <br />tA-1978-078-SG <br />George Ansley Pit <br />May 24, 2010 <br />20 <br />my U5 X1,0 <br />Division of Peclamat!on, <br />Minirg 8, Saf3bj <br />$$323.00 (Due on or before your anniversary date) <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 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 records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth Morrison <br />Permittee Name <br />Address <br />Phone Number: <br />Fax Number: <br />V- - <br />AN AL FEF1 an PORT REQUEST <br />Lincoln County <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 />J <br />Si nature of Corporate Officer, Owner, or Designee <br />FS 2? c'7 <br />4/0 <br />Da e <br />M: TERMITIMAS TERDOCUMENTS\M-AF-04