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~e9 <br />~ ANNiiAi, FF,F, and REPORT RF.OiiF.ST <br />~EC~! ~.a <br />PERMITTEE NAME: `/ Moffat Limestone Co., Inc. // ~~ <br />PERMIT NO.: ~M-2003-073 ,/ A(lG ®3106 <br />OPERATION NAME: Juniper Mountain Gravel t?rV I sl ~n at ~'p~a/s~ <br />ANNIVERSARY DATE: July 21, 2006 a°~r <br />ANNUAL FEE DUE: $688.00 (Aue 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 operator <br />shall submit the annual fee, a report and map-showing the extent of current 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 ~nnr reviced written anneal ren^rt and anm~al re nn rt mT,p to Chic form. The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: fre_...;._re nr ,and associated <br />maµ (A113 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that air adequately labeled map that clearly delineates mrd includes the above e[enrems may <br />saffice for a writtere report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Datryl L. Steele <br />Permittee Name: Moffat Limestone Co., Inc. <br />Address: 62207 U.S. 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 />~ ~ ~~~ <br />Signatur f Corporate Officer, Owner, or Designee <br />~" ~+j`6lr <br />Date <br />