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!?3113/2006 11:26 9708240356 <br />PERMITTEE NAME: <br />PERMTf NO.: <br />OPERA'1TON NAME: <br />ANNIVERSP.RX DATE: <br />ANNUAL FEE DiJI;: <br />COUNTY: <br />Moffat County <br />M-1978-007 <br />MDFFAT COUNTY ROAD <br />Big Burn Pit No 17 <br />RECE~'~/ED <br />MAR 13 2006 <br />Febraary 23, 2006 <br />Division of Minerelt b Geology <br />$688.00 (Due an or before your anniversary date) <br />Moffat <br />According to C.R.S- 3432.5-116 or C.R.S. 3432-116, each year, on the anniversary date of the permit, an <br />operator shall subaut the annual fee, a report and map showing the extent of cwrent disturbances to affected <br />land, reclamation accomplished to hate 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 />begirming of active operationa, and the date active operations ceased for the year, if any. <br />PL ase attach ynnr revise,Lwrit4en snnnal report and annnnl re~nrt maw to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a wriraen <br />report. <br />Division records indicate the following permittee contact information. .Please verify and make any necessary <br />changes: <br />Penmittee Contact: Billy E. Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-3211 <br />(97U) 824-0356 v <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 farm along with your writ~~n..teport-and map. Annual Report instructions aze <br />enclosed. STUC'KPTLE RHt7U'C'CIUIV ONLY,~NII ;MAP'NECESSAkY~ <br />'7f~~ <br />Si~~cttatore ot7~orate Officer, Owner, or <br />Billy E. 14ack, Director Moffat Co.uny Road R bridge <br />/-! P -OL <br />Date <br />~;s' .na-ae <br />PAGE 03 <br />