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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 UEST <br />kaca County <br />?/M-1993-088 <br />Gunkel Pit No 31 <br />March 7, 2010 <br />K- <br />eIVED <br />/MAR 012010 <br />DM$Wn of Keclamatwn, <br />Wng 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 as repoitt and map showing tfie 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 man 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 map 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: Glen R. Ausmus <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 />encloseed. <br />Signature of Corporate Officer, Owner, or Designee <br />,2, - zL--::?a/l <br />Date <br />M:\PERMTT\MASTERDOCLJMENT S\M-AF-04