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III IIIIIIIIV <br /> IIIIII III <br /> ANNUAL FEE and REPORT REQUEST RECEIVEp <br /> PERMITTEE NAME: Moffat County <br /> MAY 112001 <br /> PERM IT NO.: M-1978-085 Division of Minerals and CeologV <br /> OPERATION NAME: Smith Pit No 20 <br /> ANNIVERSARY DATE: May 25,2001 <br /> ANNUAL FEE DUE: $550.00(Due on or 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 /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 attach your revised written annual report and annual report map to 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: Dennis R. Jones <br /> Permittee Name: Moffat County <br /> Address: P.O. Box 667 <br /> Craig, CO 81626 <br /> Phone Number: (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 instructions are <br /> enclosed. I;o i,ew lAsturbance — O'tockpile ,:;eduction Gnly <br /> Signature of Corp ate icer or Owner <br /> Dennis R. Jo s (Road oupervisor) <br /> Date <br /> M:TER M ITMASTER DOCUMENTSW-AF-61 <br />