2004-10-25_REPORT - M1984168

• Permit No: M1984168
• IBM Index Class Name: Report
• Doc Date: 10/25/2004
• Doc Name: Annual Fee/Report/Map
• From: Williams Fork Mining Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

Q~5
PERMTITEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Williams Fork Mining Company
M-1984-168
Williams Fork Pit
October 25, 2004

OCT 2 5 ZC04
Division oa P~iiacr-' t ^^.olaBY
$688.00 (Due on or before your anniversary date)
Moffat
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
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 yeaz, the dates for the beginning
of active operations, and the date active operations ceased for the year, if ,any.
Please attach ynnr revised written anneal re,~nrt and anneal re~nrt m ~n to Chic form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Forest 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.
G~r',°'".°f~ ~J~/~;, l~~e~, 'Gen. M~gr_
Signature of Corporate Officer, Owner, or Designee
f_ 20. a.oo~
Date