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rvt~L~i <br />d~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Williams Fork Mining Company <br />M-1984-168 <br />Williams Fork Pit <br />October 25, 2006 <br /> <br />R~~-~~s,~-~ <br />//6ivision of Reclamation, <br />Mining antl Safety <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 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, ieclama4ion that wi 1 p rfo'rmed 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 vour revised written annual reuort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the arevious vear and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Reuort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Forrest V. Luke <br />Permittee Name: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970)826-6140 <br />(970)824-6136 <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 />Signature f Corporate Officer, Owner, or Designee <br />~r~ ~L'.3 ZlJO~o <br />Date <br />