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r <br />~ J <br />/ / <br />ANN-UAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Moffat County Board of County Commissioners ~ ' ,' J ' <br />PERMIT NO.: ~ -2006-076 ~ ~.~ ^ ~ ~~ ~ ~~ <br />~ c ~ a, <br />OPERATION NAME: State Pit No. 38 ~ <br />ANNIVERSARY DATE: January 31, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />_ _ _ According to C.R.S._34_32.5-11.6-or C.R.S_ 34_32-116,. each year, on the. anniversary_date_of the permt,_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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated mau. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's man are necessary. then no new man is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tom Gray <br />Billy E Mack, Director <br />Permittee Name: Moffat County Board of County Commissioners <br />Moffat County Road Dept <br />Address: 221 West Victory Way PO Box 667 <br />Craig, CO 81625 Craig, CO 81626 <br />Phone Number: (970) 824-5517 (9 70) 82 4- D? 11, E x t _ 15 <br />Fax Number: <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 />7 ~ /L <br />Signature of ~ rporate Officer, Owner, or Designee <br />~- ~~-~1 <br />Date <br />M:~PERMITU~iASTERDOCLTMENTSU~I-AF-04 <br />