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~~~ <br /> ANN1JAi, FFR and RF.PnRT R ROiIF,ST fl~~~H V ~~ <br /> <br /> DEC 1 1 ypp~ <br />PERMITTEE NAME: Moffat County <br /> <br />PERMIT NO.: <br />M-1989-112 Diaision o} PAinerals and Gnolapg <br />OPERATION NAME: Refuge Pit #1 <br />ANNIVERSARY DATE: December 8, 2003 <br />ANNUAL FEE DUE: $281.00 (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 annual fee,-a repvrrand-tTTap shtiwing-the-extent-af currenrdistar)sances-to affected) <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 will 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 report and annnal rennrt m ~n 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 />PetTnittee Contact: 43ennie3eae~ <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-3211 <br />(970)824-0356 <br />~'• l~ k1~ l'Vl.?L~~ <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. <br />Stockpile Reduction Only - No Map Necessary <br />Signature orporate Officer, Owner, or Designee <br />I 1 , l Sl- o~ <br />Date <br />M;~PERM 17U1ASTER DOCUMENTSU-I-A F-04 <br />Total $969.00 <br />