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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-197&079 <br />Daugherty Pit <br />May 24, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <br />RECEIVED <br />MAY 0 1 2003 <br />Division of Minerals and Geaiagy <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 _ I <br />- operatorshall-submit-the-amlual-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 ynnr revised written annnal rennrt and annnal report m~ to this form. Please ttote that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: ~--~~Ft9~'743=2515 `7 t9. 7~,3-a33 7 - - <br />Fax Number: -{1-I9j-743835' ~ i9 - `2 ~.3 ' ~~ t-S <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 />I~ <br />nv~ ~Y~-- <br />Sign~a/ture of Corporate Officer, Owner, or Designee <br />~ T /~~ ~©~ <br />Dale <br />M:~PERMITUA ASTERDOCUMENTSUI-AF-(14 <br />