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03/25!2005 14:27 9708240356 MOFFAT COUNTY ROAD PAGE 03 <br />i <br />~~ <br />~/ <br />.~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPI?RATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL PILE DUE: <br />COUNTY: <br />Moffat County <br />M-1978-007 <br />Big Barn Pit No 17 <br />February 23,2005 <br />$688.00 (I)ue on or before yoar anniversary date) <br />Moffat <br />3 <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 the upcoming year, reclamation that will be perforated 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 />P1nasP attach yrnnr revic dwriften an_ nr~al re~M and nna_ n?I rennrt mtm to this form Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since jor a written <br />report. <br />Division records indicate the following pernlittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy E. Ivlack <br />Permittee Name: Moffat Couttty <br />Address: P.O. Box 667 <br />Craig, CO 81626 <br />Phone Number: (970) 824-3211 <br />Fax Number: <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 instnutions are <br />enclosed. <br />S?OCKPILE REDUCTION - NOf~MAP NECESSARY. <br />Sign Corporates Off cr, Owner or Designee <br />~ IG~ •c^ti <br />Date <br />