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J-% FEB.16.1999 4:11P: DIViMIN III'II'lllll'llllll <br />ANNUAL REPORT <br />PERMITTER NAME: Baca County <br />PERMIT NO.: M-77-479 <br />• N0. 124 P.3i11 <br />Qc-p# -N (D~7/ <br />~ J~- l01~ 30 so <br />RECEIVED <br />FEB 241999 <br />OPERATION NAME: Gravel Pit No. 2 Geo1o9Y <br />p;~sion of Minerals 8 <br />ANNPJERSARY DATE: September 11,1998 <br />AATIUAL FEE DUE ON ANNNERSARY DATE: $225.00 <br />COUNTY; Barn <br />In order to ensure that our records aze up to date, please attach your revised annual report map and written <br />report to this annual report. Note that a written report is not aecessarv if the map addresses all the <br />items listed in the attached instructions concerning ntinine disturbance and reclamation update. <br />Please type or print the current contact person's name, mailing address, and phone ntlmber in the space <br />provided: <br />COIItaCt Name: R~ Mi 11 r/ Ta k Carson <br />Address: 741 Main <br />CoIIlpeny:Baca Coun~p o misa;on rs Dist. I <br />PhoneNo.: (719 1 5 3-fi532 <br />Faz No.: l 71 9 ) 52'1-fi5R4 <br />_ s <br /> <br />,,8 gnature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ONBACK <br />M:1w~~nrwdcElgarn Coumy.0ee <br />