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<br />A? -A- W1' <br />ANNUAL FEE and REPORT REOUEST <br /> C <br />PERMITTEE NAME: Moffat County RECEIVRD <br />PERMIT NO.: M-2000-033 APP 28 2011 <br />OPERATION NAME: Villard Pit #2 Division cl 1-%6im,'Iiriatior.. <br />P <br />ANNIVERSARY DATE: May 31, 2011 Wing and Safety <br />L <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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 <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 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 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 <br />Billy E. Mack <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Moffat County <br />P.O. Box 667 <br />Craig, 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(Df Corporate Officer, Owner, or Designee <br />t-I -JItl <br />Date <br />RECEIVED <br />APR 28 k0'l 1 <br />plvision of Reclamation, <br />Mining & Safety <br />M: \PERMITIMAS TERDOCUMENTS\Nl-AF-04