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~"w.. <br />'A~ ~ ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEENAME: Moffat County <br />PERMIT NO.: M-1978-085 <br />OPERATION NAME: Smith Pit No 20 <br />ANNIVERSARY DATE: May 25, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />~~~~~~~ <br />MAY 1 6 200, <br />Division of Keclarnation, V <br />Mining and Safety C./ <br />_ . _ According_to_C.R.S._3.4--32.5_1 l_6_or C.R.S._34-32-116, each _year,_on -the -anniversary date-of the permits 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 your 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, report, and <br />associated map. If no new disturbances or reclamation have occurred durinE the previous year and no <br />new changes to the previous year's map are necessary, then no new map 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: 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) 824-3211 <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 />Signature Corporate Officer, Owner, or Designee <br />~t -t ~-Mz <br />Date <br />M: PERMIT\MASTERDOCUMENTS~Iv1-AF-04 <br />