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fiEC~~~o,;=f~ Cbl„~ <br />;/ JAN 3 0 2006 <br />Division of Minerals and C~Iogy~NNiiAi. FF,F, and RF.PnRT RF.niTF,ST <br />% "~~ <br />p_ <br />~~ r:1 <br />i~ ~~U <br />~ ~'~i,' <br />6 , 11 <br />PERMITTEE NAME: / Moffat County <br />PERMIT NO.: / M-1978-007 <br />OPERATION NAME: Big Burn Pit No 17 <br />ANNIVERSARY DATE: February 23, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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-atmual-fee,-a-report and-map-showing thecxtcnt-of-current-dis.arbancas to-af~cted- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that whll 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 ynnr revised written annnal re~nrt and annnal re nn rt mwn to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy E. Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Craig, CO 81626 <br />Phone Number: (970) 824-321 I <br />Fax Number: 1970) 824-0356 <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. STOCKPILE REUUCCION ONLY. iJ0 P1AP NECESSARY. <br />Si afore orporate Officer, Owner, or Desi ee <br />B~1"ly E. Mack, Director Moffat Coun~y Road & Bridge <br />Date <br />" , _ <br />M:~PERMr11MAS7ERD000MENTSNr-AF-09 <br />