2006-05-17_REPORT - M2005006

• Permit No: M2005006
• IBM Index Class Name: Report
• Doc Date: 5/17/2006
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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v ANNTiAT. FF,F, and RF.PT)RT RF.nTTF1ST
PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
%~/Moffat County
M-2005-006
Powderwash Pit No. 66
June 17, 2006
RECyE9~gnE~'®
v MA1 1 ~ LUUU
v Division of Minerals and GeslogY
$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 yeaz, 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, reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to
occur during the upcoming yeaz, reclamaton that will be performed during the coming yeaz, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach yJym revised writt n anm.al re~nrt and anmral rPnnrt ma~tn 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: Billy E. Mack
Permittee Name:
Address:
Moffat County
CF.PR.address_1
P.O. Box 667
Craig, CO 81626
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 aze
enclosed.
Signatur - Corporate Officer, Owner, or Designee
.i - 1 C~ - c7 f'
Date
M:~PERMI'NNA57IItD0(:UMENTSUS-AF-04