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/~' <br />h JAG) <br />t/ ANNi1Ai. FFF, and RF,PnRT RF.n1TF.ST <br />RECEiVE1~ <br />PERMITTEE NAME: / Lincoln County <br />PERMITNO.: /M-1987-016 /~~~.~ <br />OPERATION NAME: County Line Pit „/ DiWtlooof Mlnualsand0eWaBY <br />ANNIVERSARY DATE: Apri17, 2006 <br />ANNi-JAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Lincoln <br />According to C.R.S. 3.4-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />-- --operator-sha11_-submit-the. annual fee,-a_report-and_map showing the extent.of_currentrdisturbances_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 ynnr revised written anneal re~nrt and anneal rennrt morn to this form. Please note that an <br />adequately labeled mcp that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Blake <br />Permittee Name: Lincoln Cotmty <br />Address: P.O. Box 39 <br /> Hugo, CO 80821 <br />Phone Number: (719) 743-2337 <br />Fax Number; ('119) 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 />~ ~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~3°a77~oS~~ <br />Date <br />M:IPERM17VvfA5TERIX)CUME4TS~M-AF-04 <br />