2001-07-02_REPORT - M1995019

• Permit No: M1995019
• IBM Index Class Name: Report
• Doc Date: 7/2/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

T = III IIIIIIIIIIIII III
ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: Baca County
PERMIT NO.: M-1995-019 SUL
OPERATION NAME: Mundell Estate No.32 ., r.w n al Minerals and Gealu9Y
ANNIVERSARY DATE: May 1,2001
ANNUAL FEE DUE: $225.00(Due on or before your anniversary date)
COUNTY: Baca
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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to dale and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report man to this form. Please note that air
adequately labeled map that clearly delineates and includes the above elements may suffrce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ray Miller
Permittee Name: Baca County
Address: 741 Main St.
Springfield,CO 81073
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
4S' ature of Corporate Officer or Owner
&/�A 9b /
Date
M:IPERMrnMASTERDOCUMEN SN.AF-04