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o~ I <br />PERMITTEE NAME: <br />PE1tMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />N~~ r~~% <br />AN AL FEE and PORT REQUEST <br />/Lincoln County <br />,i1~I-2005-044 <br />Hoffman Pit <br />August 10, 2007 <br />~- <br />~G 0 2001 <br />D' Sion of Reciarc~ation, <br />Mining and Safety <br />5323.00 (Due on or before your anniversary date) <br />Lincoln <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 <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 report 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 durinc the previous vear and no <br />new chances to the previous year's map are necessarv,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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -BemBlake <br />Permittee Name: Lincoln County <br />Address: 103 3rd Ave. <br />P.O. Box 39 <br />Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number: (719) 743-2815 <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 />Signa re of rat Officer Owner, or Designee <br />.~ u ~.,,, to j ~N O7 <br />Dat~ <br />M:~PERMITMASTERD000MENTSVd-AF-04 <br />