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<br />~ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: t~ <br />Moffat County <br /> / <br />PERMIT NO.: I/ M-1998-047 <br />OPERATION NAME: Mautle Pit #3 <br />ANNIVERSARY DATE: September 9, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your <br />COUNTY: Moffat <br />~~ <br />RECE~uED <br />~ AUG 2 5 2006 <br />vDlVlslon of Reclamation, <br />Mining and Sarc~„ <br /> <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />]and, reclamation accomplished to date and during the preceding yeaz, riew disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO S 1626 <br />(970)823-3211 <br />(970)824-0356 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. MAP ATTACHED SH0IJING DISTUR$ANCE TO DATE. <br />-~11P,, ~ ~1~2A~~ ~ <br />Stgnatu~Corporate Officer, Owner, or Designee <br />~-~~d~ <br />Date <br />M:\PERMITMASTERDOCUMENTSM-AF-04 <br />