2006-05-02_REPORT - M1999043

• Permit No: M1999043
• IBM Index Class Name: Report
• Doc Date: 5/2/2006
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ ANNTIAT, FF.F, and REPORT RF, iTF,fiT
Lincoln County
t/M-1999-043
C & D Farms No. 2
May 11, 2006
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$281.00 (Due on or before your anniversary date)
Lincoln
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 cca om'lished~to date and Burin the recedin
p g p g year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ymrr revised written annual rennrt and anneal re~nrt main 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 permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Don Blake
Permittee Name: Lincoln County
Address: P.O. Box 39
Phone Number:
Fax Number:
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.
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Sig/nature of Corporate Officer, Owner, or Designee
Dale
RECEIVE®
MAY 0.2 2006
Oioisiaa of Miaerab ead CGed~
M:~PERMITN.]ASTERDOCUMEMS~M-AF-04