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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />,~~ ~ RPr <br />ANNUAL FEE and R-EP~ORT REQUEST <br />Lincoln county j <br />M-2002-108 <br />Eikermann <br />October 29, 2007 <br />RECEIVED / <br />OCT 0 9 ZUU7 / <br />Division of Reclamation, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Lincoln <br />~lecer~l_ng=c r,n.c, 3~-32:5-.i1( ur .t' R ~- -34_3ovt t_i5~_eaclt-year on the anniversary date. of the Hermit 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 report and annual resort 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 sufface 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-Bielce- <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Lincoln County <br />P.O. Box 39 <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. ~ ~p___ ` <br />~ Imo? ^ .,.~~ ~\~A'~/~AAts--'- <br />Signature of Corporate Officef, Owner, or Designee <br />5~4.~ 200. 1 <br />Date <br />M1PERMIN1ASTERD000MENTSU4-AF-04 <br />