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A V -k- UT <br />ANNUAL FEE and REPORT REOUEST .- <br />2 7 2010 `? <br />PERMITTEE NAME: ,.,Moffat County Board of County Commissioners S <br />PERMIT NO.: M-2009-060 Division of i-ts; + s=++at n, -101 <br />, jng 2nd Safsty <br />OPERATION NAME: Clay Pit No. 21 <br />ANNIVERSARY DATE: October 19, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />Accordins to C R.S?34_32.5-116 or C_R: 34-32-116 eac g ar,_on th -knniversary-- te_of the-p -qm ,._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 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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanLyes 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: Tom Gray <br />Permittee Name: Moffat County <br />Moffat County <br />Billy Mack <br />Board of County Commissioners <br />Address: 221 W. Victory Way <br />Craig, Co 81625 <br />Phone Number: (970) 824-5517 <br />Fax Number: <br />Craiq, 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 />Signatur o orporate Officer, Owner, or Designee <br />r-- ga-'lP <br />Date <br />M: PERMITIMASTERDOCUMENTS\M-AF-04