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ANNTiAi. FF.F, and RF.Pt1RT RF.niTF.ST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Moffat County <br />M-1980-239 <br />Sweeney Pit No 30 <br />December 19, 2004 <br />/ ~ ~~ <br />~"' 0 two <br />$688.00 (Due on or before your anniversary date) <br />Moffat <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 />---°----land, reclamation,accomplished to date and during the preceding year, new 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 ynnr revised written annnal rennrt and anm~al rennrt m ~n to this form. Please note that Rn <br />adequately labeled map [hat clearly delineates and includes the above elements may since 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 E. Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970)824-9249 <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. <br />Reclamation on BLM portion on West side. Stockpile reduction only on East side. <br />%~ , ~.n ~ ~/1/lcx t <br />Signature orporate Officer, Owner, or Designee <br />November 10. 2004 <br />Date <br />M:~PERMITUTASTERDOCUMENTSNI-AF-04 <br />