2005-10-17_REPORT - M1984168

• Permit No: M1984168
• IBM Index Class Name: Report
• Doc Date: 10/17/2005
• Doc Name: Annual Fee/Report/Map
• From: Williams Fork Mining Company
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME: "W' Hams Fork Mining Company ~
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PERMIT NO.: -1984-168
OPERATION NAME: Williams Fork Pit
ANNNERSARY DATE: October 25, 2005
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COiJN"I'Y: Moffat
- _-According to_CR.S._34-32.5-116_or_C.RS. 34_32-1 l6, each year, on the anniversary date of the permit, an oQerator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual refit m ~n to this form- please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following percnittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Forrest V. Luke
Permittee Name: Williams Fork Mining Company
Address: P.O. Box 187
Phone Number:
Fax Number:
Craig, CO 81626
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Sign f Corp ro ateate Of~ facer' Owner, or Designee

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