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f ~/ <br />ANNUAL FE>` and REPORT REQUEST <br /> ~ <br />PERMITTEE NAME: d Moffat Limestone Company <br />PERMIT NO.: ~ -1982-141 <br />OPERATION NAME: Jumper Quarry <br />ANNIVERSARY DATE: August 9, 2007 <br />~,Q(~ <br />~~.~;~ Y <br />~~~~~ <br />d °j~,o Gd;~ ~® <br />!/'°~/~~n9a asa a a©~n <br />~ ' <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. 34-32-1 ] 6, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected ]and. <br />reclamation accomplished to date-and-during thepreceding 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 your revised writtep annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clenrly delineates and inchtdes the <br />above elernents may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Darryl Steele <br />Permittee Name: Moffat Limestone Company <br />Address: 62207 US Hwy 40 <br />P.O. Box 205 <br />Maybell, CO 81640 <br />Phone Number: (970) 272-3215 <br />Fax Number: (970) 272-3215 <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 />1~~?~51e%°~vT <br />Signatu o Corporate Officer, Owner, or Designee <br />~~-_ <br />Date <br />