2006-11-24_REPORT - M1989112

• Permit No: M1989112
• IBM Index Class Name: Report
• Doc Date: 11/24/2006
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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~/ ANNUAL FEE and REPORT REQUEST
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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Moffat Couuty
~M-1989-112
Refuge Pit #1
December 8, 2006
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$$281.00 (Due on or before your anniversary date)
Moffat
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____ According to C.R.S. 34-32.5-116 or C.R_S. 34-32-116, each year, on the anniversary_date_o£-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 aze anticipated to
occur during the upcoming year, reclamation that will be performed during the coming yeaz, 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. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred during the previous vear and no
new chances to the previous year's map are necessary. then no new map is required. provided that the
Operator shall state this in the Auuual Report. Please note that an adequately labeled map that clearly
delineates and includes the above eleme~ats 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:
Address:
Phone Number:
Fax Number:
Moffat County
P.O. Box 667
Craig, CO 81626
[phone]
[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 aze
enclosed. Stockpile Reduction Only - no new map necessary,
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Signature of Corp e Officer, Owner, or Designee
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Date
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