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999 <br /> <br />ANNUAL REPORT <br />~ ~ag~o~ <br />~~ ~~g~i <br />PERMITTEE NAME: Costilla County <br />PERMIT NO.: M-1999-024 ~~c~~~~ <br />OPERATION NAME: San Acacio Gravel Pit 1 ~ ti~~ <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: 281.0 ~~tSEPtM`~e`~\Sa~d~eo\o9~ <br />$ Op <br />COUNTY: Costilla <br />According to C.R.S. 34-32-116(3)(a), 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 <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming yeaz, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. <br />Please note thnt an adequatefy labeled map t/iar clenrly delineates and includes tl:e above <br />elements n:ny suffice for a writrert report. <br />Please type or print the current contact person's name, mail <br />space provided: i~ <br />Contact <br />,~. <br /> <br />SRI. E,u15 CO ~-152, <br />°~l ~ <br />in the <br />PhoneNo.: (7r`1 ) G`1z-33`1?, <br />FAXNo.:i `11q) 11`1.-39toz, <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it [o this report form along with your map and/or <br />written report. <br />Signature of orpo e Officer, o Owner Date <br />INSTRUCTIONS ON BACK <br />M:~PERM fM1A5TERD000MENTSUI-AF-04 <br />