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f ? <br />.a . '- R1 <br /> <br />r <br />Ar A, <br />ANNUAL FEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: aca County <br />PERMIT NO.: 7M-1977-485 <br />OPERATION NAME: Gravel Pit No 8 <br />ANNIVERSARY DATE: September 11, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Baca <br /> <br />RECEIVED <br />0 7 2010 <br />?2 QWsion of Redamaw?, <br />&Oft & Sal* <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 andmap 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 vour 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 chances to the previous vear's man are necessarv. then no new man 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: 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 />bellow or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />I Lem 4/4-e' <br />fgn r of Corporate Officer, Ow er, or Designee <br />Date <br />M:1F'ERMIT\MASTERDOCUMENTSW-AF-04 <br />