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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Moffat County <br />M-1980-248 <br />Lyons Pit No 2 <br />February 4, 2002 <br />2 ~(~ <br />RECEIVED <br />FEB 0 41002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />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 report and map showing the extent of current disturbances [o affected <br />land, reelamation 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, [he dates for [he <br />beginning of active operations, and the date active operations ceased for [he year, if any. <br />Pease attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled-map [hat clearly delineates and ihcludes 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 />Permi'ttee Contacts Dennis Jones <br />Permitkee Name: ~ Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Craig, CO 81626 <br />(970)824-3211 <br />Fax Number: (970) 824-0356 <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 instmctions are <br />enclosed. Stockpile Reduction Only - No D7ap Necessary <br />Signa e of Corporate Officer or Owner <br />Billy E. Niack (Supervisor Road Department) <br />~3i1o2. <br />Date <br />M:~PERM ITU4ASTERDOC UM ENTSNI-AF-06 <br />