2004-12-01_REPORT - M1989112

• Permit No: M1989112
• IBM Index Class Name: Report
• Doc Date: 12/1/2004
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Moffat County
M-1989-112
Refuge Pit #1
December 8, 2004
$281.00 (Due on or before your anniversary date)
Moffat

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 disturbances 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 attac~ynnr revised written annnal rennet and annnal re~nrf man 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: ~ennir.Ter+ss ~ L' , ~'Y/ a. c /(
Permittee Name: Moffat County
Address: P.O. Box 667
Craig, CO 81626
Phone Number: [phone]
Fax Number: [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 are
enclosed.
STOCKPILE REDUCTION ONLY
Signature of Co orate Officer, Owner, or Designee
Dale
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M:~PEAM171MASTERDOCUMENTSNr-AF-04