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na3~L <br />.:: a ~hP <br />., <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiIAi. FF.F, and RF.PtiRT RF.t7iTF.ST <br />c/Baca County <br />q ~^05 <br />/M-2003-070 ~~'' ~ ~ <br />Hinds Pit #35 <br />January 8, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Baca <br />_ __ _. Acc.Q[ding_t9 ~.R.S._3_432S=L16 or CRS.~A~32-Llb; 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, reclamafion 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 annual red nrt and annnal re,~nrt maw to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Wright <br />Permittee Name: Baca County <br />Address: 741 Main St. <br /> Springfield, CO 81073 <br />Phone Number: (719) 523-4sa~ ~ ~ 9) 5~3 -~ 532> <br />Fax Number: (719) 523-6584 <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 />enclose . <br />„/,~~ <br />Iat~ur/e of Corpora e Officer, Owner, or Designee <br />I/l. ~~~ <br />Da[e~ <br />M:WERMITMASTEROOCUMENTSUI-AF-04 <br />