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;; <br />III IIIIIIIIIIIIIIII ~ <br />a~~ o <br />ANNUAL REPORT <br />PERMITTEE NAME: Costilla County ~EC'E~V~® <br />PERMIT NO.: M-1994-103 ~.'1l~~ 3Q ~~~ <br />OPERATION NAME: Sierra Grande Site piviSinnolMinetalS~Ge010Q~ <br />ANNNERSARY DATE: June 6, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $225.00 <br />COUNTY: Costilla <br />According to C.R.S.34-32-116(3)(x), each year, on the anniversary date ofthe permit-an ' -- - --' <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach Your revised annual report map and written report to this annual report. <br />Please note that nn adequateh~ labeled map that c/early delineates crud includes the above <br />elements mny suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: ~~/Z~B~/~ ~/fG~~d Company: LOS, i~L,A C'ou,u~"y <br />Address: ~ O. /yox lOD Phone No.: (71`~ ) (o`7~,Z- 3372 <br />S',r+-t.~ ~,I.trS CO SllSz FAX No.: (7l°I ) (~`TZ-391oZ, <br />If there are additional comments and/or information that should be provided [o the Division, <br />please provide it on a sepazate sheet and attach it to this report form along with your map and/or <br />written report. <br />i <br />U c<-C~v~-c/'~- o~ - O~ '~ off(/~ <br />Sign• ure of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M ~PERh1fIV.7ASTERD000MENTSNI-AF-bi <br />