2005-02-11_REPORT - M1980248

• Permit No: M1980248
• IBM Index Class Name: Report
• Doc Date: 2/11/2005
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

03/25/2005 14:27 9708240356 MDFFAT COUNTY ROAD PAGE 02
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PERMITTEE NAME:
Pl3RMIT NO,:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTX:
Moffat County
M-1,980-248
Lyons Pit No Z
February 4,2005
$688.00 (Aue on or before your aggiversary date)
.Moffat
According to C.R.S. 34-32.5-11G 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, reclamation accomplished to date and daring the pmeeding~year, new disturbances that are anticipated to
occur during the upcoming yeaz, reclamation that will be performed during the coming yeaz, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Ple c___~,P aNagh yn rr~iaed written anmral re~rf_and annual report man fn fhia fnrm_ ,P(2ase note that art
adequately labeled map that clearly delineatev and includes the above elements may .ru~ce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name;
Address:
Phone Number:
Fax Number:
Silty E. Mack
Moffat County
P.O. Box 6G7
Craig, CO 81626
(970) 524-32] 1
[phone]
If yeu 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.
STOCKPILE REDUCTION AND RECLAMATION ONLY. ND SIGNIFICANT INCREASE IN DISTURBANCE.
N MAP NECESSARY.
.~~ ~~
Signature orporate Officer, Owner, or Designee
Date