REP01584

• Permit No: M1978085
• IBM Index Class Name: Report
• Doc Date: 5/27/2005
• Doc Name: Annual Report
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Reclamation Report
• Media Type: D
• Archive: No

~~:
MAY 2 ~C05
~s
Uiviaianothtirerals&Ganl Qy
ANNUAi. FF.F, and RF.PnRT RF.niIF.ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Moffat County
M-1978-085
Smith Pit No 20
May 25, 2005
$688.00 (Due on or before your anniversary date)
Moffat
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
__- o~eritorshall s_ub_mit the annual_fee,_a_report and=map showing-the extent_o~cunentdsturbances 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 ym.r revised written annnal rennrt and annnal report mad to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Billy E. Mack
Permittee Name: Moffat County
Address: P.O. Box 667
Craig, CO 81626
Phone Number: [phone]'
Fax Number: [phone]
(No Changes required)
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. Stockpile reduction only - no map required.
Signa Corporate Officer, Owner, or Designee
~~ °~ `-1- 0.S
Date
M:~PERMIPMASTERD000MENTS~M-AF-0O