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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL PEE DUE: <br />COUNTY: <br />ANNUAL Flsr and R1;PORT Rh;OUCST <br />Baca County <br />M-1977-484 <br />Grave! Pit No 7 <br />September 11, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Baca <br /> <br />SEP 0 9200'1 <br />pirisien of Minerals end Geology <br />According to C,R.S. 34-3Z.5-I I6 or C.R.S. 34-32-I I6, 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 arc 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 resort and annual resort man to this form. Please note t/mt nn <br />ndequn4dy labeled map tsar clearly delineates and inchrdes the shove elemeru.c ntcry stffice jor u written <br />report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Troy Crane <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />I <br />~i. <br />Springfield, CO 81073 <br />Phone Number. (719) 523-6532 <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 />enclo;gd. <br />r:Ji <br />/'- ~ 'i~ <br />w.l . W . e/Yl'N~II . <br />S gnaw of Corporate Officer, Owner, or Designee <br />?yJo 2 <br />Date <br />hl: U'1!NMI'IUtAS'I'I1NU(%)Uhl f N'r5lhhAl'd}1 <br />