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.=. <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAL FEE and REPORT REQUEST <br />RECESI/ED <br />Baca County <br />M-1993-087 <br />Weeden Pit No 30 <br />February 24,2002 <br />APR 0 2 2R~7 <br />Division of Miner.: ~: aTd Caolv~Y <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 Co date and~uring tthe preceding yyear, new disturbances that aye 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. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufftce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ray Miller <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />Springfield, CO 81073 <br />_ Phone Number: (719) 523-6532 <br />Fax Numbec (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 instmctions are <br />enclosed. <br />~, ~~~ <br />Signature of Corporate Officer or Owner <br />~ ~ <br />Dale <br />7 ~~~ ~~o/30G? t <br />~~~a' l~ <br />~~~ew ~~ ~ ul~s <br />Npf GGSe~ «v ~~~~ <br />M:~PERM I'nMASTERDOCUMENTSVN-AF-04 <br />