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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Moffat County <br />M-1978-085 <br />Smith Pit No 20 <br />May 25, 2002 <br />RECEIVED <br />MAY 0 6 ZOQ2 <br />Oirision of Minerals and GeolaBY <br />$688.00 (Due on or before your anniversary date) <br />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 />• ---operater-shall~ubmit~h~nual.fee, ~ YPpnrt_and_map choiuing~the-exteut_nLcurrent_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 vour revised written annual resort and annual resort man 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: }D'eki~iiXRXlnk~'"s <br />Permittee Name: <br />Address: <br />Craig, CO 81626 <br />Phone Number: <br />Fax Number: <br />Moffat County <br />P.O. Box 667 <br />(970)824-3211 <br />(970)824-0356 <br />Billy E. Mack (Supervisor) <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. Stockpile Reduction Only - No Map Necessary <br />~~' ~,~ <br />Si~rtature'ef Corporate Officer or Owner <br />Billy E. Mack (Road Supervisor) <br />Dale <br />-r'1-o <br />M:NERM ITN4ASTERD000MENTSVv1-AF-04 <br />