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~, <br />v' Baca County <br />1/ ANNiTAi, FF.F, and RF.PnRT RF.(IiTF.ST <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />,/ "M-1978-225-L <br />McVey Pit <br />Apri128, 2006 <br />a~ ~ <br />~w^.t .~~1(:..~ <br />•~ MAR 1.~ 2006 <br />Division of Mmerais and Geology <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 ym~r revised written annual re~nrt and annnat repo m n this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 />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 farm along with your written report and map. Annual Report instructions are <br />enclosed. <br />igna a of Corporate Officer, Owner, or Designee <br />~_R-oln <br />Date <br />M:WERMITMASTERD000MENTSVN-AF-04 <br />