2003-06-26_REPORT - M1981138

• Permit No: M1981138
• IBM Index Class Name: Report
• Doc Date: 6/26/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVEC
JUN Z 6 2003
Division of Minerals and Gealagy
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Baca County
M-1981-138
Gravel Pit No 17
July 24, 2003
$281.00 (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 submit-the-annual-fee, a report-and-map`showing the extent of cur~enfdi§turbances to affected
land,-reclamation accomplished to date and-during [he 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 anneal reRnrt and anmral rennrt m,~ to this form. please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Tom,, ;4_
Permittee Name: Baca County
Address: 741 Main St.
Springfield, CO 81073
'-'"""P116ne Nu`m-ber. t T9)-523=bS~
Fax Number: [phone]
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.
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,/'7~1~ n--~-~
Signature of Corpor e Officer, Owner, or Designee
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Date
M:\PERMITMASTERDOCUM ENTS\M-AF-04