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<br />V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNiIAi. FF.F and RF,PORT RF.(liiF,ST <br />! RECEIVED <br />Baca county AUG 2 9 2003 <br />M-1977-484 <br />Division ~f Minerals and Geology <br />Gravel Pit No 7 <br />September 11, 2003 <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 />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 ynnr revised written annual report and anneal rennrt man to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Troy Crane <br />Petmittee 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 />gnam of orporate Officer, Owner, or Designee <br />Sl /,~.y/a 3 <br />Date <br />M:\PERMITVdASTERDOCUMENTSUI-AP-04 <br />