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-r <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Baca County <br />M-1993-088 <br />Gunkel Pit No 31 <br />March 7, 2004 <br />FEB 2 0 2004 <br />Division of Minerals & GoolApy <br />$688.00 (Due on or before your anniversary date) <br />Baca <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 />epeeste~shall-submit-the-anrtual-fee,-re-report-and-map showing_the-extenk of. cuerent_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 y~rr revised written anmral re;~nrt and anneal re~nrf main to this form- Please nofe that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 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 />..r,cb ~~' ~ r~~ <br />Signature of Corporate Officer, weer, or Designee <br />Date <br />d <br />M:~PERMITMASTERD000MEMSNI-AF-04 <br />