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~~;r <br />~~ ~ R~Pt <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AN1V-UAL FEE and REPORT REQUEST <br />Baca Count '~~ <br />Y <br />M-2003-019 <br />Re-open gravel pit #18 Pipe Springs Ranch LLC <br />Apri128, 2008 <br />~c~fv~® / <br />008 v <br />APR 0 3 2 <br />Division of ~eC8afety n~ / <br />Mining and <br />$$323.00 (Due on or before your anniversary date) <br />Baca <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, reclamation acc~~mplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcciming year, reclamation-that wi11-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 your revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If rio new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includE~s the above elements may suffice for a written report. <br />Division records indi~~ate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Troy Crane <br />Permittee Name <br />Address: <br />I3aca County <br />7'41 Main St. <br />S'~pringfield, CO 81073 <br />Phone Number: ('719) 523-6532 <br />Fax Number: ('719) 523-6584 <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 Report instructions are <br />enclosed. <br />~~ <br />Signa of Corporate Officer, Owner, or Designee <br />~-- r~ ~~ <br />Date <br />M:~PERMIIIMASTERDOCUMENTSV~i-AF-04 <br />