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<br /> ~~ ~Q~ <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: ANNUAL FEE and REPORT REQUEST <br />Williams Fork Min/ing Company ~ <br />M-1984-168 / <br />RECE~~~ED,~ <br />QCT Z 5 2~0~ <br />n <br />OPERATION NAME: Williams Fork Pit , <br />pivision of Reclamatio <br />Mining and Safety <br />ANNIVERSARY DATE: October 25, 2007 <br />ANNUAL FEE DUE: $$791.00 (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, ea_ch_year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of cureent disturbances to affected land, -- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual resort mau to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the urevious vear and no aew chances to <br />the previous year's map are necessary, then no new man is required. provided that the Operator shall state <br />this in the Annual Report. Please note tha[ an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the fallowing pennittee contact information, Please verify and make any necessary <br />changes: <br />Permittee Contact: Forrest V. Luke <br />Permittee Name: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Craig, CO 81626 <br />Phone Number: (970) 826-6140 <br />Fax Number: (970) 824-6136 <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 enclosed. <br />irvr~an--~ ~- <br />Signature Corporate Officer, Owner, or Designee <br />C~c~3, ~.o~~ ~ <br />Date <br />