2006-03-29_REPORT - M1998003

• Permit No: M1998003
• IBM Index Class Name: Report
• Doc Date: 3/29/2006
• 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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9w~oron of Minerals and Gc+olo9YANNiiAi, FF.F, and REPORT RF.OiTF.ST fir` "~~
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PERMITTEE NAME: UMoffat County ~I 4~ .i ~1~:
PERMIT NO.: i/M-1998-003
OPERATION NAME: /Raftopoulos Pit #1
ANNNERSARY DATE: April 28, 2006
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY; 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,-reciamatiori accomp7i`shed-fo da et-arid during the preceding year; new dtstur antes 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 attach your revised written annual repprt and anm~al report main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
C! 6M
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Billy E. Mack
Moffat County
Address:
Phone Number:
Fax Number:
P.O. Box 667
Craig, CO 81626
[phone]
[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. S70CKPILE REDUCTION ONLY - NO P9AP NECESSNRY
Signature Corporate Officer, Owner, or Designee
Billy E. P4ack, Director
Pdarch 10. 2006
Date
M:~PERMI'11MASTERDOC[IM ENTSUI-AF-04