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~ ~ _ ' ~J <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMTI' NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lincoln County <br />M-1988.022 <br />Smith Ranch Pit No 2 <br />May 16, 2002 <br />R~C~ ,~® <br />A; .; 1 1 ZOflp <br />D%Y%Slon of Minerels and ~eelogY <br />$281.00 (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 [he. annua]_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. Please note that an <br />adeguately labeled map that clearly delineates and Includes the above elements mcry suffice for a written <br />report. <br />Division records indicate the following pelmittee 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 />Phone Number: <br />Fax Number: <br />Hugo, CO 80821 <br />(7]9)743-2337 <br />(719)743-28]5 <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 ins[mctions are <br />enclosed. <br />r <br />Signature of Corporate Officer or Owner <br />8 ~//t3~ ~n 2 <br />Date <br />M:tPERMIT~MASTERDOCUMENTS~M-AF-04 <br />