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<br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Moffat County <br />M-1989-112 <br />Refuge Pit #1 <br />December 8, 2002 <br />~ECE~VE® <br />DEC 122002 <br />division of Minerals and Geolag~ <br />$281.00 (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 yeaz, 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 to affected <br />--land, ieclamanon accomplishe to ate and duribg the preceding year, new disturbances that are anticipate t~ o <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 your revised written annual report and annual report map to this form. Please note drat an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: %I616)6dkXR~~k~ <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 />Billy E. Mack (Interim Director) <br />If you have additiona comments and/or information that should be provided to the Division, please provide it <br />below or attach tt this form along with your written report and map. Annual Report instructions are <br />enclosed. Stockpile Reduction Only - No Map Necessary <br />~. ~QU ~!l~t~,.t~ <br />Signatur f Corporate Officer, Owner, or Designee <br />Billy E. Mack, Interim Director <br />December 3, 2002 <br />Date <br />M:~PERMrM4ASTERD000MENT5UI-AF-04 <br />