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(:?5p '), (? ?'r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />F <br />Moffat County <br />?M-2005-006 <br />Powderwash Pit No. 66 <br />June 17, 2010 <br />.CejV D <br />f ?ealam?ttpn, <br />plot&lott ® 009& saietj <br />$791.00 (Due on or before your anniversary date) <br />Moffat <br />--_-According te-?R.S::3!?-32:5-1=16 or ?1?5?34?2 . ?ae1?yea?-.?o tlae an?iver?aty_dale-o€-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 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 />Phone Number: <br />Fax Number: <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 />-'z 4"-k <br />Signature of orate Officer, Owner, or Designee <br />6-rv--(n <br />Date <br />M: \PERMITgvIASTERDOCLTMENTS\M-AF-04 <br />