2005-08-11_REPORT - M1977485

• Permit No: M1977485
• IBM Index Class Name: Report
• Doc Date: 8/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Baca County
• To: DMG
• Media Type: D
• Archive: No

AF r~r^7
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Ba~ County ~~ ~
/M-1977-485
Gravel Pit No 8
September 11, 2005
$688.00 (Due on or before your anniversary date)
Baca
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According 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 shall submit_the_annuals'ee,_a_report_and.mapshowing the-extent-of-current-disturbances to-affected-
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anneal re~nrt and anneal rennrt mad to this form. Please note [hat an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Troy Crane
Permittee Name: Baca County
Address: 741 Main St.
Springfield, CO 81073
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Si atu/yE~ f 1C~~orporate Officer, Owner, or Designee
Y+ J 1F J ~ SJ
Date V\ o
M:~PERMITUTASTERDOCUMENTSUI-AF-04