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ANNUAL REPORT <br /> PERMITTEE NAME: Moffat County �FCE/V�Q <br /> PERMIT NO.: M-98-047 - <br /> l)iy� ®C 719 <br /> OPERATION NAME: Mantle Pit#3 0J7OtMi a1.8 G99 <br /> ANNIVERSARY DATE: September 09, 1999 ��JY <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br /> COUNTY: Moffat <br /> According to C.R.S. 34-32-116(3)(a), 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 <br /> to affected land, reclamation accomplished to date and during the preceding year, new <br /> disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br /> performed during the coming year, the dates for the beginning of active operations, and the date <br /> active operations ceased for the year, if any. <br /> Please attach your revised annual report may and written report to this <br /> annual report. Please note that an adequately labeled map that clearly delineates and <br /> includes the above elements may suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the <br /> space provided: <br /> � . -� �S <br /> Contact Name: is ' Company: <br /> Address: to )4 e,e, Phone No.: (?7 0 ) 8 2- 3 Z 1 I <br /> C 2Pr t Ca g 1 /a Z G. Fax No.:L2• D ) B — 3s ?, <br /> If there are additional comments and/or information that should be provided to the Division, <br /> please provide it on a separate sheet and attach it to this report form along with your map and/or <br /> written report. 4NMenw- t,30 <br /> 7/Z. <br /> Signature of Co orate Offi er, or Owner Date <br /> INSTRUCTIONS ON BACK <br />