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,"� *- 0 r- <br /> ANNUAL FEE and REPORT REOUEST <br /> PERMITTEE NAME: Moffat County <br /> ----,OCT i anPERMIT NO.: M-2002-059 ✓ <br /> OPERATION NAME: Sunbeam Pit#1 Division or nd Saf sttion, <br /> Mining and afetj <br /> ANNIVERSARY DATE: October 1,2009 <br /> ANNUAL FEE DUE: $791.00(Due on or before your anniversary date) <br /> COUNTY: Moffat <br />_ According_to—CR_S._34_32.5n11f—or .R S. 34-32-11�� eacear, o�the anniversarydate 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 may to this form. The Annual <br /> Report & Fee requirement is not met until we have received the following components: fee, report, and <br /> associated may. 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 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 /> Craig,CO 81626 <br /> Phone Number: (970) 824-3211 <br /> Fax Number: (970) 824-0656 r;o1�0� �Zy 0351a, <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 /> Signatu Corporate Officer, Owner,or Designee <br /> /0 F--C)!z <br /> Date <br /> M:\PERMITq%IAS TERDOCUMENTS\M-AF-04 <br />