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.w/ <br />dli~ <br />T ,, <br />.- <br />ANNUAL FEE and RETORT RE VEST <br />PERMffTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ Baca County <br />/M-2003-070 <br />Hinds Pit #35 <br />January 8, 2007 <br />/~FEB 0 6 2007 <br />(/Division of Reclamation, <br />Mining and Safety <br />$$688.00 (Due on or before your anniversary date) <br />Baca <br />--according-to-C:I2:3-342:5-1-16-or-C:R:S: 34-32=1-f6,-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 yeaz, 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, resort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary, then no new map is required, arovided 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: I,, ^ ~I \~- <br />Permittee Contact: Bill Wright ~'e.-!~ ~ i~-IJ~IIJ~ <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />Phone Number: <br />Fax Number: <br />Springfield, CO 81073 <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 form along with your written report and map. Annual Report instructions aze <br />enclose <br />Signature of Corporate Officer, Owner, or Designee <br />2 z D <br />Date <br />M:~PER~97U1ASTEADOCi7MEN'r$Ud-AF-04 <br />