2010-10-20_REPORT - M1984168 (3)

Home Browse Search

ANNUAL FEE and REPORT REOUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Williams Fork Mining Company M-1984-168 Williams Fork Pit October 25, 2010 of $791.00 (Due on or before your anniversary date) ?'fy Moffat 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation _accomplishe&to -date-and-during the-preceding-year, new-disturbances-that-are-anticipated-to--occur - -- during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report man to this form. The Annual Report & Fee requirement is not met until we have received the following components fee, report, and associated man. 1f no new disturbances or reclamation have occurred during the previous year and no new changes to the previous vear's man are necessarv, then no new map is reauired. provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Forrest V. Luke Permittee Name: Williams Fork Mining Company Address: P.O. Box 187 Phone Number: Craig, CO 81626 (970) 826-6140 Fax Number: (970) 824-6136 If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. C ignature of Corporate Officer, Owner, Designee Date