2005-08-11_REPORT - M1977484

• Permit No: M1977484
• IBM Index Class Name: Report
• Doc Date: 8/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Baca County
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
~aca County -~~
M-1977-484
Gravel Pit No 7
September 11, 2005
$688.00 (Due on or before your anniversary date)
Baca

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
--operator-shall-submH-Ehe-annual-fee,-a-report-and-map showing-the extent-of current-disturbancesto-affected-'----
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annnal report and annnal rep on rt matn to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may sufftce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Troy Crane
Permittee Name: Baca County
Address: 741 Main St.
Springfield, CO 81073
-P ofi ne Numbei:-" [phone]
Fax Number: [phone]
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If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
gnatu of Corporate Officer, Owner, or Designee
~'~~`--ate
Date
M:~PEAMITNIASTERDOCUMENTS~hI-AF-04