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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Baculite Mesa LLC <br />M-1997-011 <br />Baculite Mesa Pit <br />July 9, 2002 <br />RECESVED <br />J(/(~ ~ ~ <br />Division o/Minerals and CeoloBY <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <br />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 />snau suorru[ me annuat ree, a report ana map snowing me extern or curtem atsturoances w arrecreu rams; <br />reclamation accomplished to date and during the preceding yeaz, 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. Please note that an <br />adequately labeled mnp that clearly delineates and includes the 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: Fred J. Orr <br />Permittee Name: Baculite Mesa LLC <br />Address: 5040 Acoma <br />Denver, CO 80216-2010 <br />Phone Number: (303) 295-1216 <br />Fax Number: (303) 295-1256 <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions aze enclosed. <br />Signature of Co orate Officer or Owner <br />~CIZ-`!1 p'i~ <br />Date ~ <br />M:~PERM77'IMASTERDOCUMENTSU4-AF-01 <br />