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(~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Costilla County <br />M-1999-024 <br />San Acacio Gravel Pit <br />October 4, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Costilla <br />RECEIVED <br />OCT 01 2002 <br />Division of Minerals and Geology <br />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 <br />- - -operator shall submit-the annual fee, a-report arrd-map~showi"ng th"e e~nf of cuiren[ disturbances to affec[ed <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 resort and annual resort map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice fora written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact; Mathew L. Valdez <br />Permittee Name: Costilla County <br />Address: P.O. Box 100 <br />San Luis, CO 81552 <br />Phone Number: (719) 672-3372 <br />Fax Number: (719) 672-3962 <br /> <br />~-o . t?~.ak iaa <br />-- - --~lt`t~Gz-"tZ -~ri6°~ - <br />l tit - ~~ Z- 3003 <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 />enclosed. <br />Signature of Corporate Officer, Own ,, ore <br />°1~3~ ~07, <br />Date <br />M:NERMITVv1ASTERD000MENTSNI-AF-04 <br />