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ANNUAL FEE and REPORT REQUEST ? <br />PERMITTEE NAME: ,?? Moffat County <br />PERMIT NO.: ? M-1978-085 <br />OPERATION NAME: Smith Pit No 20 <br />ANNIVERSARY DATE: May 25, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />,K; ,? <br />?t <br />APR 2 3 2010 <br />Division uT i-twciarnabon, <br />Wning and 8aMty <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-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 channes to the previous vear'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) 824-0356 <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 />Signature orporate Officer, Owner, or Designee <br />9-1-16 <br />Date <br />M: PERMITIMASTERDOCUMENTS\M-AF-04