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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />7 <br />B ca County <br />?M-2003-070 <br />Hinds Pit #35 <br />January 8, 2009 <br />t?fL <br />J? <br />,Dtc Q 3 008 <br />T EC 3 12o08 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (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 your revised written annual report and annual report map to this form The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new may is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Peter L. Dawson <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />Springfield, CO 81073 <br />Phone Number <br />Fax Number: <br />(719) 523-4521 <br />(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 orm along with your written report and map. Annual Report instructions are <br />enclose <br />Signature of Corporate Officer, Owner, or Designee <br />2 ?? d g <br />Date <br />M: \PERMIT\MAS TERDOC UMENTSN-AF-04