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<br /> P~' ~ 2~" <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITT <br />NAME i <br />l <br />C <br />: <br />EE L <br />nco <br />n <br />ounty <br />PERMIT NO.: M-1991-060 <br />OPERATION NAME: Ravenkamp Pit No 1 <br />ANNIVERSARY DATE: October 8, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <br />RECEIVED <br />OCT 0 3 2007 J <br />Division of Reclamation, <br />Mining and Safety <br />--According_to-C.R.S.~4-32.5-1.16_ox C.R.S._34-32=116,. each_yeaz,.orLthe.anniversary_date of the~ermit, 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 vour revised written annual resort and annual reuort map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated maa. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary, then no new maa is required, urovided 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: -Ben-Kielce' <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(719) 743-2337 <br />(719)743-2815 <br />Kenneth Morrison <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 />r-- <br />Si ature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PEAMITUTASTERDOCUMENTSNI-AF-04 <br />