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f r 1Q 1?? <br />ANNAAL FEE and REPORT RE VEST <br />PERMITTEE NAME: ? offat County Road Dept. R ?? w ??? <br />DEC 2 0 2008 <br />PERMIT NO.: M-2006-076 <br />and d Saf Safey <br />OPERATION NAME: State Pit No. 38 7r? y0 Division Mining and Reclamation, <br />ANNIVERSARY DATE: January 31, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />a?- <br />_According_to C.R.S.._3_4-32.54ll6 or C.R.S._3_4-32-11.6,_each year, on-the-anniversary -date of the_permit,_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 during the previous year and no <br />new chances to the previous year's map are necess_arv, 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 since 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 Road Dept. <br />Address: P O Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-3211 <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 o Corporate Officer, Owner, or Designee <br />Date <br />M:\PERMIIIMASTERDOCUMENTS\N4-AF-04