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<br />PERMITTEE. NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />a-- * ef-T- <br />ANNUAL FEE and REPORT REOUEST <br />Moffat County <br />M-1980-239 <br />Sweeney Pit No 30 <br />December 19, 2009 <br />RMSIM <br />DEC 012009 <br />Division of Reclamation, <br />Mining and Safety <br /> <br />$791.00 (Due on or before your anniversary date) <br />Moffat <br />-According-to C.R.S._3432-5=1L6-or C.R.S-3432116,_each_y_ear,_on_the-anniversary-date-o£xhs_-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 vour 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 maw. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's may 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) 824-9249 (970) 824-3211 <br />Fax Number: (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 />15 -' s' <br />Signature .,orporate Officer, Owner, or Designee <br />Date <br />M: \PERMIT\MAS TERDOCUNMNTS\M-AF-04