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.. <br />- • • , iii iiuiiiiiiii-iii~ <br />f +t~ ~ ~ .-.~cGE1 999 <br />a PN 21 Z~~~ <br />ANNUAL REPORT <br />,,,,,ecals &GapVO9Y <br />PERMITTEE NAME: Moffat County -`- L l`. <br />PERMTI' NO.: M-1978-007 ~'I I~ ~ <br />OPERATION NAME: Big Burn Pit No 17 ~` ~~~ 2 119 <br />ANNIVERSARY DATE: February 23, 2000 ~1 ~- - <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 `~- <br />COUNTY: Moffat <br />According to C.R.S. 34-32-1 lti('3)(a), each yeaz, on [he anniversary date ofthe 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 yeaz, new <br />disturbances that aze anticipated to occur during [he 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 map and written report to this annual resort. <br />Please note that an adequately labeled Wrap that clearly delineates mtd includes the above <br />elements may suffice for n written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />f"lort=a-T I~OJaJ~~ l~~~D i7fc.pi <br />Contact Name: Company: <br />Address: P. p • ~o >C LPG 7 Phone No.: (9 70) $ 2~ - 3 2../ <br />~2.ALG t L) O ~ I!P Z-ti 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 [his report form along with your map and/or <br />written report. <br />Signature of <br />1.~0 ~~~ L7~ Si vs2f3~r.7~,~ - /l10 !~ /.~P <br />1J ~C~ s 5.c~2,.-~ <br />or Owner <br />/-~~~ ~o <br />Date <br />INSTRUCTIONS ON BACK <br />M'NERM frU1ASTERD000M EM'SU1-AF-Oi <br />