2006-07-12_REPORT - M2005044

• Permit No: M2005044
• IBM Index Class Name: Report
• Doc Date: 7/12/2006
• Doc Name: Annual Fee/Report/Map
• From: DMG
• To: Lincoln County
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMTI' NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Lincoln County
M-2005-044
Hoffman Pit
August 10, 2006
RECEI~lED
JUL 12 2006
Division of Minerals and GealaBY
$281.00 (Due on or before your anniversary date)
Lincolu
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
operator shall submit_the_annual_fee,_a report and map showing the extent of_cun•ent disturbances to. affected _
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming yeaz, reclamation that will be performed during the coming yeaz, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following pennittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Don Blake A`~ ~~
Permittee Name:
Address:
Phone Number;
Fax Number:
Lincoln County
103 3rd Ave.
P.O. Box 39
Hugo, CO 80821
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
~1--~~
Signature of Corporate Officer, Owner, or Designee
Date
M:IPERMITURASTERDOCUMENTSUI-AF-04