REP52666

• Permit No: M1998003
• IBM Index Class Name: Report
• Doc Date: 4/1/2002
• Doc Name: 2002 Annual Report
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Moffat County
M-1998-003
Raftopoulos Pit #1
Apri128, 2002
~~
RECEIVED
APR 0 11002
DiviSien of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Moffat
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
- -"land, reclamatian'accomplistieti to Hate and fluring'the' preceding-year; new disturbances that ate antieipated [o - - - --
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report. No Map Necessary
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: 1ii~~IvY
Permittee Name:
Address:
Phone Number:
Fax Number:
Moffa[ County
P.O. Box 667
Craig, CO 81626
[phone]
[phone]
E. Mack
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed. Stockpile Reduction Only - No Map Necessary
Signature d#~orporate Officer or Owner
Billy E. Mack (Supervisor) Moffat County Road Department
3 -I1 -off
Dale
M:~PERM17U1ASTERD000MENTSVN-AF-04