2001-12-06_REPORT - M1989112

• Permit No: M1989112
• IBM Index Class Name: Report
• Doc Date: 12/6/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Moffat County
M•1989-112
Refuge Pit #1
December 8, 2001
Dirisioa of Minerals and GeslopY
$281.00 (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
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 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 vour revised written annual report and annual report map to this form. Please mote that an
adequately labeled snap that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Perrnittee Contact: Dennis Jones
Permittee Name: Moffat County
Address: P.O. Box 667
Phone Number:
Fax Number:
Craig, CO 81626
[phone]
[phone]
RECEIVED
DEC 0 6 2001
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. Stockplie Reduction Only - No Map Necessary
Si atur Corporate Officer or Owner
BP~lly E. Mack (Supervisor)
I1-I Z-Dt
Date
M ~PERMrM1ASTERD000MENTSN7-AF-(li