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ft F 4- Q Y <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Moffat County / ME Ct <br />PERMIT NO.: / M-2002-059 J S?? 2 7 2010 <br />OPERATION NAME: Sunbeam Pit #1 .D, Division or Neui?j-crtatn, <br />+i? arr?i ?a#at`l <br />ANNIVERSARY DATE: October 1, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />According-toXR:S. 34-32.5-146-or-C.R.S.-34-32-1-16, 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 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) 824-0656 <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 />-OL <br />Signature orporate Officer, Owner, or Designee <br />Date <br />M: \PERMITIMAS TERDOCUMENTS\M-AF-04