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<br />t ~J <br />PERMI'I"I EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Lincoln County <br />M-1985-109 <br />Arthur L Schmeiser <br />August 6, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Lincoln <br />RECEIVED <br />JUL 1 '0 2110'1 <br />DlVision ai Minerals and Cenlegy <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-]16, each year, on the anniversary date of the permit, an _ <br />operator shaltsdbmit the anneal-fee, a report and map showing tfie extent of current disturbances to affected i <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 report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following petlnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Blake <br />Permittee Name: Lincoln County <br />Address: P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: ['F?9J-7#~'Y83S~~ ~ ~4~ ~~~ ` ~f 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. Annua] Report instructions are <br />enclosed. <br />of Corporate Officer or Owner <br />Date <br />M 1PERM ITVNASTERDOCUMENTSUd-AF-04 <br />