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~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Williams Fork Mining Company <br />M-1984.168 <br />Williams Fork Pit <br />October 25, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Moffat <br />RECEIVED <br />ocrz5z~z <br />Division eFMinerals and Geology <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 operator <br />_ _.- _shalLsuhmit_the_annuat_fee, a_report and_map_showing the_extent_of current disturbancee_to_affected_land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 since for a written report. <br />Division records indicate the following permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Forrest V. Luke <br />Permittee Name: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Craig, CO 81626 <br />Phone Number: (970) 826-6140 <br />^" Fax Number. (970) 824-6 ] 36 <br />9 7 t~-= 8z.ro --fa 13:~ - <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature Corporate Officer, Owner, or Designee <br />~~~ ~,z z,oaz <br />Date <br />M:~PERMI7NIASTERD000 MENTSNI-AF-01 <br />