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i; <br />1 <br />ANNUAL FE n~REPORT REQUEST <br />PERMTTTEE NAME: / Baca County RECEIVE D <br />PERMff NO.: '~M-1981-138 ~iJUL 0 3 2007 <br />OPERATION NAME: Gravel Pit No 17 -13ivision of Reclamation, <br />ANNNERSARY DATE: July 24, 2007 Mining and Safety <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Baca <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each~ear on the annivers_arv_ date of the perm_ itLan _ _ <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, rec]amation 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 report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous vear and no <br />new chances to the previous year's map are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annnal Resort. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact informa n. Please verify and make any necessary <br />changes: /~ <br />Permittee Contact: ~i~l~dpng~lt ~ ~ . I <br />Permittee Name: Baca County <br />Address: 741 Main St. <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 thi form along with your written report and map. Annual Report instructions are <br />enclosed./ <br />~~ <br />Signatur~f Corporate Officer, Owner, or Designee <br />Date <br />M:NERMITMASTERD000MENTSNI-AF-04 <br />