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=1 <br />:~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />RECEIVED <br />AUG 1 g 1003 <br />Division of Minerals and Geology <br />Baca County <br />M-1977-485 <br />Gravel Pit No 8 <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-a*mual-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 att~h ynnr revised written annual rennrf and annual rennrt mgp to this fnrm_ p/ease note that an <br />adequate/y labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Troy Crane <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 />'gna of Corporate Officer, Owner, or Designee <br />S/~~~D 3 <br />Date <br />M:\PERM I"M~ASTERDOCUMENTSUI-AF-04 <br />