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., -~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Baca County <br />M-1993-087 <br />Weeden Pit No 30 <br />February 24,2005 <br />$688.00 (Due on or before your anniversary date) <br />Prowers <br />FED 10 2G~5 <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />--`--land'reelamatiorr-accomgfished-to date-andduring-the-preceding-year,-new disturbances.that are anticipated_to _ _ _ <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymir revised written anneal rennrt and anm~al rennrt m,~ to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: //'l ' ' ~1 <br />Permittee Contact: ~'Iv[filer- (rte I~ ~ ~• ~~J~~ <br />Permittee Name: Baca County <br />Address: 741 Main St. <br />Springfield, CO 81073 <br />Phone Number: (719) 523-6532 <br />Fax Number: (719) 523-6584 <br /> <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Repor[ instructions are <br />enclosed. <br />>~. R. <br />Signature of Corporate Officer, Owner, or Designee <br />- /$ -O <br />Date <br />M:~PERMI7\MASTERDOCUMENTSN1-Ar-09 <br />