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.~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME; <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Moffat County <br />M-2000-033 <br />Villard Pit #2 <br />May 31, 2002 <br />uR,,ECE~VED <br />,DIY 0 6 <br />Division of l yineruts end Geology <br />$688.00 (Due on or before your anniversary date) <br />Moffat <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall-submit-the-annual-fee,-a~report-_and_map_ showing_the_extent_of cuuent_dis[utbances_t~affecl~d~agd,_ <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pemuttee Contact: %~3eX~~$.~+Y,~ <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Moffat County <br />P.O. Box 667 <br />Craig, CO 81626 <br />(970)824-3211 <br />(970)824-0356 <br />Billy E. Mack (Supervisor) <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ to [his form along with your written report and map. Annual Report instructions are enclosed. <br />Stockpile Reduction Only - No Map Necessary <br />Si ~t~Corporate Offic r or Owner <br />Silly E. Mack e(Road Supervisor) <br />-I')-D <br />Date <br />M iPERMITU1ASTERD000MENTSU4-AF-OI <br />