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3 r,'iL~ <br />~teU) <br />i <br />ANNUAI. FF. F. and RF:I UR'1' NF:(?IIF.ST <br />RECFr`<iD <br />I'ERMI'1`I'IiL=. NAMIi: Moffat LimcvUrnc Company <br />PI•:RNn'r Nt). ~ M-1982-lal ~ AUG 03 ~ <br />UI'FI(A'I'ION NAMI•:: .lunipcrOurrry ~ ~'f• r~~"~ntit, <br />nc,,p:.n.i r;eorr.Gr <br />ANNIVI•:KtiARY DA 11{: Aul;ust 9, 2006 <br />.4NNl IAl ITF DI II $550.(10 (Due on or before your anniversary date) <br />t'Ol )N'fY' Moffat <br />According to C.R.S. !a•!Z.S-I 16 ur (~. R.ti. is-32-I I6, each year. un the annivlKSary' date o(Ihc 11l'rrTn t. 811 tlpl•I'a G)r <br />sh:dl tiubmn the annual Ice. a rclxnt and map showing the rztent of current disnuhances to a(tcc•tcd I:uut. <br />rcclnmutiun accomplished to dale and dunng the pnxeding ycnr. new drshrrbanccs that arc anucgvucd 6r occur <br />dunng the upcoming year, reclnmmum that will he pcrfirrmrd dunng the cunung year, the dates for the hcguuung <br />ui uchve operunons, and the ctatc active uprraunns ceased tin the year, it any. <br />f'Ituce attach Your revived written annual reuort and annual report man to this form. I'hr Annual Report <br />fi Fee requirement ix not met until we have received the following congronenty: fee, renrrrt, and asxociated <br />mar (All arc required rel;ardless of the level of dishrrbanve or absence of disturbance durBrK the previous <br />rear). l4cu.cr nun• Nrut rut udnpmndr' lulrr•lyd nmp dint rlrur-h' dr6nratrs trod inrludc., rhr uhutr rlrrnenl, nrur <br />vrllrrr !nr a u-ripen rtqurrt <br />Division mcrrrds indicate the following permitlce contact utfonnation. Please venly and makr nny ncccs:uy <br />chanKcs: <br />Pcrntiltcc Contact Darryl Stcclc <br />I'crnTit[cc Numo: MofGd I.imcstone Company <br />Addreas: 622117 US Ilwy all <br />I'.O. Ilos 2U5 <br />Mayhcll, ('O K l (r3U <br />I'h„nr lnntbci~ I')'Ol 2'2-!215 <br />I.rs t\huiihcr 1`)7(112)2_}215 <br />It' you have adduiunal comments andror infomration Thar should be provided to the I)ivrsum. please provuie n <br />bclow• rn attach rl to this form along with your wrnlcn report and map. Annual Rcpon instnrchuns are enclosed. <br />;' ~1 I . , <br />Si~matur~ t~fCorporatc Uliicer, Owner, or Iksi~*nee <br />7 ,. _~ <br />• N ~ J <br />Date ~ <br />a~s~rwt.e.P.~i.. . <br />