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i` )--- Ci2. &,e z 7a.) <br />I f ANNUAL FEE a R EPORT REQUEST _ <br />RgCEN PERMITTEE NAME: CLi coin County V OCT 0 5 2011 <br />PERMIT NO.: 1991 -060 Division of Reclamation, <br />Mining and Safety <br />OPERATION NAME: Ravenkamp Pit No 1 <br />ANNIVERSARY DATE: October 8, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <br />E1ccording to C7R- -34- 32.- 5- 1 -16 -or C —.R-S: 34 -32- 116, -each _year,_on the_anniversar . Jate 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: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Si <br />e . *k (7) 2 \' ‘ <br />Dat <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 />M:IPERMIT\MAS TERDOCUMENTS\M -AF -04 <br />ature of Corporate Officer, Owner, or Designee <br />11)fic, <br />