REP00039 ‎(2)‎

ANNUAL FEE and REPORT REQUEST RECEIVED
FEB 0 3 2004
PERMITTEE NAME: Baca County Division of Minerals 1.t;eplea�
PERMIT NO.: M-1993-087
OPERATION NAME: Weeden Pit No 30
ANNIVERSARY DATE: February 24,2004
ANNUAL FEE DUE: $688.00(Due on or before your anniversary date)
COUNTY: Prowers
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
a, . .all-submit-the-anp_aal-fee,-a-report-and_map-showing the extent-of current disturbances to affected
land, reclamation accomplished to date 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 mash 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:
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.
Signature of Corporate Offic er, or Designee
! U 0
Date
MAPERMJTMASTERDOCU ENTSM-A -N