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A F + " -'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 />Op <br />Moffat County <br />M-1980-239 <br />Sweeney Pit No 30 <br />December 19, 2010 <br />$791.00 (Due on or before your anniversary date) <br />Moffat <br />./ NOV z 6 2010 <br />D ry OT K068n WOn, <br />J / lfir+i?+g and 9141Y <br />According_to C.R.S._3.4-32.5-LL6-or--C.RS.-3432-1-L6,--each year3-on-the-anniversarA da+e--,f the pe mid-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 may. If no new disturbances or reclamation have occurred during the previous vear and no <br />new changes to the previous year's may are necessary, then no new may 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 />Craig, CO 81626 <br />Phone Number: (970) 824-3211 <br />Fax Number: (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 />Signature q?fCorp Officer, Owner, or Designee <br />it - 0, L-1- 1 6 <br />Date <br />M: \PERMIIIMAS TERDOCUN=S\M-AF-04