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NF .?- JZ?T <br />ANNUAL FEE and REPORT REQUEST RECF-wED <br />PERMITTEE NAME: David A. Lincoln L?l <br />PERMIT NO.: M-2001-038 .? JUL 15 200b t/ <br />OPERATION NAME: Bennett Sand & Gravel Pit #2 Mining Division Mining and Safety L' <br />ANNIVERSARY DATE: August 6, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv, then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David A. Lincoln <br />Permittee Name: David A. Lincoln <br />Address: 50500 E. 72nd Ave. <br />Bennett, CO 80102 <br />Phone Number: (303) 644-3030 <br />Fax Number: (303) 644-4743 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />blow or attach it to this form algAg your written report and map. Annual Report instructions are enclosed. <br />Signatufd of Corporate Officer, Owner, or Designee <br />/ 140 <br />Date