2006-04-28_REPORT - M1995019

• Permit No: M1995019
• IBM Index Class Name: Report
• Doc Date: 4/28/2006
• Doc Name: Annual Fee/Report/Map
• From: Baca County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
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Baca County
~ APR 2 82006
Y M-1995-019
Drvisioo of MinerelsaeA Gnolagy
t/~ Mundell Estate No. 32
May 1, 2006
$688.00 (Due ou 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 current disturbances to affected _
-- ~tand,-reclamatiori accbtnplished`to dafe and`dunng tfie 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 rennrt and annnal re,~nrt main 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: n I" -n
-liey-1~fiFter q[t;Y~ ~• ~7V 1~/17(~tQ
Permittee Name: Baca County
Address: 741 Main St.
Springfield, CO 81073
Phone Number: ~ [phone]
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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Signature of Corporate Officer, Owner, or Designee
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Date
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M:~PERMITVNASTERDOCUMENTSNI-AF-04