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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Moffat Cou <br />nt <br />y Road Department RECE-VED <br />PERMIT NO.: f <br />~ <br />~~~' ~ DEC 012000 <br />OPERATION NAME: Sweeney Pit No 30 <br />Or~rsr0° °1Mtn <br />ANNIVERSARY DATE: December 19, 2000 erals and Ge°logy <br />ANNUAL FEE DUE: $688.00 (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, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during [he upcoming year, reclamation that will be performed during the coming year, [he 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 report map to this form. Please mote [ha[ an <br />adegsurely labeled rnap [hat dearly delineates antl urducles [he above elements rngv suffice jor cr wriuerr <br />report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dennis Jones <br />Permittee Name: Moffat County Road Department <br />Address: P.O. Box 667 <br />Craig, CO 81626 <br />3z,1 t ~ 51- <br />Plrone Number: (970) 8249i+l9' (91~ $ L - 3 Z 1 ~ <br />Fax Number: (970) 824-036 <br />If you have additional comments and/or information [hat 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 instnrctions are <br />enclosed. stockpile Reduction Only - Iwo f.':ap lvecessary <br />Signature of <br />Dennis R. <br />Dale <br />Owner <br />Supervisor) <br />M ~PERMITVNASTERDOCUAfENT5U1-AF~Oi <br />