2005-02-10_REPORT - M1993087

• Permit No: M1993087
• IBM Index Class Name: Report
• Doc Date: 2/10/2005
• Doc Name: Annual Fee/Report/Map
• From: Baca County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

., -~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Baca County
M-1993-087
Weeden Pit No 30
February 24,2005
$688.00 (Due on or before your anniversary date)
Prowers
FED 10 2G~5
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'reelamatiorr-accomgfished-to date-andduring-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 ymir revised written anneal rennrt and anm~al rennrt m,~ to this form- please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: //'l ' ' ~1
Permittee Contact: ~'Iv[filer- (rte I~ ~ ~• ~~J~~
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 Repor[ instructions are
enclosed.
>~. R.
Signature of Corporate Officer, Owner, or Designee
- /$ -O
Date
M:~PERMI7\MASTERDOCUMENTSN1-Ar-09