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RE N ~C~ <br />ANNUAL FEE and REPORT REQUEST C D <br />AUG 0 7 2002 <br />PERMITTEE NAME: $aca County Division of Minerals and Geology <br />PERMIT NO.: ~ M-1981-138 <br />OPERATION NAME: Gravel Pit No 17 <br />ANNIVERSARY DATE: July 24, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Baca <br />According to C.R.S. 34-32.5..11.6_or C.R.S. 34-32-] 16, each year, on-the anniversary date of the permit; an - - - <br />operator shall submit the annual fee, a report and tnap 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, 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 your revised written annual rcoort and annual resort mau to this form. Please note that mt <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Ted Lasley <br />Permittee Name: Baca County <br />Address: 741 Main St. <br /> Springfield, CO 81073 <br />Phone Atumber: (7I9} 523-6532 - °" <br />Fax Number: (7l9) 523-6584 <br />If yott 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 />Signature of Corporate fficer or Owner <br />O-~ ~~ <br />Date <br />M:NERM 1"IUTASTERDOCUMENTSVv1-AF-04 <br />