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A?p y- 0-7 <br /> ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Moffat Limestone Co. Inc. <br />PERMIT NO.: / M-2003-073 <br />/ <br />OPERATION NAME: Juniper Mountain Gravel <br />ANNIVERSARY DATE: July 21, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />:s <br />s/ JUL 19 2010 <br />V' Divisaarn of R"c4PAWon, <br />Mining snd ,O* <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new_ disturbances that are_ anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Darryl L. Steele <br />Permittee Name: Moffat Limestone Co. Inc. <br />Address: <br />Phone Number: <br />Fax Number: <br />62207 US Hwy 40 <br />P.O. Box 205 <br />Maybell, CO 81640 <br />(970) 272-3215 . <br />(970) 272-3215 <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 enclosed. <br />Owner, or Designee <br />7 <br />Date