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At, <br />+ Rer <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Williams Fork Mining Company <br />PERMIT NO.: M-1984-168 OCT 2 .l LOGO ? <br />OPERATION NAME: Williams Fork Pit Division or Reclamation, ?j <br />Kfi! ting and Sal oty ?/ <br />ANNIVERSARY DATE: October 25, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />- r-eclamation-accomplished-to-date-and-during-the-preceding-year ,new =disturbances that are anticipated to occur - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 man to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new may is required provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Forrest V. Luke <br />Permittee Name: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Craig, CO 81626 <br />Phone Number: (970) 826-6140 <br />Fax Number: (970) 824-6136 <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 enclosed. <br />-/?o Xf, L? - <br />Signature Corporate Officer, Owner, or Designee <br />Date