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Qf + Rl? 7- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Moffat County <br />M-1980-248 <br />Lyons Pit No 2 <br />February 4, 2009 <br />RECEIVED <br />FEB 0 4 2009 ? <br />Division of Reclamation, <br />Mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />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 <br />operator shall submit the annual- eT e; a report and m`ap 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 man 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 changes to the previous year's map are necessary, then no new may 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Billy E. Mack <br />Moffat County <br />P.O. Box 667 <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 />-A. ? ", , / /m <br />Signature df rporate Officer, Owner, or Designee <br />Date <br />M:\PERMITqvLASTERDOCUMENTS\M-AF-04