2006-05-17_REPORT - M1978085

• Permit No: M1978085
• 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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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
i/ ANNtiAi, FF.F, and RF.Pt7RT RF, i~ iF.ST
//Moffat County
M-1978-085
Smith Pit No 20
May 25, 2006
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Division of Minaq/a and OnolvpY
$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
operator-shall submit the annual fee; a report and map showing the extent ofcurrent disturbances to affected
- - --land,-reclamation-accomplished-to-date and during the preceding year,-new-disturbances that-are anficipated-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 ynnr revised written anneal report and anneal rennrt map 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]
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, Map attached
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Signature, orporate Officer, Owner, or Designee
Date
M:~PERMITMASTERDOCUMENTSU4-AF-04