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4/11/2006 10:56 9708240356 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNiVERSARY.DATE: <br />ANNUAL FEE DUP.: <br />COUNTY: <br />MOFFAT COUNTY ROAD <br />Moffat County <br />M-1992-OD7 <br />Tuttle Pit No 1 <br />MarcL 5, 2005 <br />$688.00 (17ne 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 <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 performed 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 />Plenepyf~~]j~nu~ revised Writf ri ann sl r~ nrf gnd nnnngl rppnrr m`n fn this fnrm. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permiltee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy E. Mack <br />Permittee Namc: Moffat County <br />Address: P.O. Box GG7 <br />Craig, CO 81626 <br />Phone Number: (970} 824-321 ] <br />Tax Number: (970) 824-0356 <br />ff 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 <br />/ enclosed. _ <br />STOCKPILE REDUCTION ONL}(- .,t «-//,( ~t /~'~-~ ~~'e'~°L~-~ C <br />Q - -~ wR Q/C.2_ ~C.~Q~-C.CtiLQ~ ~-~ <br />Signature o rporate Offtcer, Owner, or Designee G n ~ /h~U C~~O <br />Date ~~/ /w,( <br />M:NP..RMmMA5rCit1)nCUMr,M'SNR-AF.o9 <br />