REP11065

• Permit No: M2000033
• IBM Index Class Name: Report
• Doc Date: 5/27/2005
• Doc Name: Annual Report
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Reclamation Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Moffat Couuty
M-2000-033
Villard Pit #2
May 31, 2005
$688.00 (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 of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current disturb_ances_to affected
~~' land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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 y9ur revised written annual re~nrt and annual re~nrf mad 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
Pennittee Name: Moffat County
Address:
Phone Number:
P.O. Box 667
Craig, CO 81626
[phone] -
Fax Number: [phone]
(No Changes Required)
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 - no map required.
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Signat ~ f Corporate Officer, Owner, or Designee
Date
M:IPERMITMASTERD000MEMSNi-AF-09