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~,e~P o <br />/- -ti <br />PERMITTEENAME: Moffat County RECEIVED <br />PERMIT NO.: M-1978-007 FEB 0 3 2004 <br />OPERATION NAME: Big Burn Pit No 17 Division of Minerals & GealoAv <br />ANNNERSARY DATE: February 23, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on ar 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 />operatrr'shalt-submit•the-armaai-fee-a-report-and-map showing'th~extent ~f cnrrent-disturbanoes-to~ffected--- <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 aftarhTnnr revised written anmral re~nrt and anneal reQDrt mare M 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 />Permittee Contact: Billy E. Mack <br />Permittee Name: Moffat County <br />Address: P. O. Box 667 <br />Craig, CO 81626 <br />Phone Number: (970) 824-3211 <br />Fax Number: <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 />~.a $~ ~CC L <br />Signature orporate Officer, Owner, or Designee <br />January 7. 2004 <br />Date <br />M:IPERMIriMASTERDOCUMEMS~M-AF-04 <br />