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aK <br /> - ANNUAL REPORT <br /> PERMITTEE NAME: Moffat County <br /> PERMIT NO.: M-98-047 <br /> OPERATION NAME: Mantle Pit#3 aEGE\VET <br /> ANNIVERSARY DATE: September 09, 1999 G 12 �gg9 <br /> ANNUAL FEE Moffat <br /> ON ANNIVERSARY DATE: $550.00 o`N�'o otM�tayp,GgO�y <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 yew <br /> disturbances that are anticipated to occur during the upcoming year, reclamati at will be <br /> performed during the coming year, the dates for the beginning of active oper;1b s, and the e <br /> active operations ceased for the year, if any. Q& 1 <br /> Please attach your revised annual report map and written report t <br /> annual report. Please note that an adequately labeled map that clearly d neat s d <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 /> Contact Name: Company: <br /> Address: P• D - nneaO u &,L 7 Phone No.: (? <br /> C2/� lCo � C gI � ZL Fax No.: <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. -Vq0MW- tJ e) J-4 Q:TW iT� -1-0 1:�T — <br /> �I p M A(� tJ z..Ci✓SS/�2y <br /> 7/23/,j9 <br /> Signature of Co orate Offi er, or Owner Date <br /> INSTRUCTIONS ON BACK <br />