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r rvt~Y <br />~~ ..` ~ oz,o(o ~7 <br />~~~~ <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 />Baca County <br />i/ M-1993-087 <br />Weeden Pit No 30 <br />February 24, 2007 <br />R~~~~~'~ <br />~'e >~ <br />0 <br />~v/n/on of 6?00j <br />~Llinin9 a Cosa e~,on, <br />ly <br />,9p,N ~ 6 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Prowers <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 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, 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 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 mau. If no new disturbances or reclamation have occurred during the urevious year and no <br />new chanties to the previous year's map are necessary, then no new mau is required, provided that the <br />Operator shall state this in the Annual Report. 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 information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Glen R. Ausmus <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 this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />- 2 - ~ <br />M:~PERMITMASTERDOCUMENTSIM-AF-04 <br />