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1 <br />PERMITTEE NAME: a County Pp 1 7n i 9 <br />PERMIT NO.: - 2008 -035 lvisi of Reclamation, <br />Minlwlj and Safety <br />OPERATION NAME: Moser Pit <br />ANNIVERSARY DATE: September 24, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Yuma <br />According to C: R: S734= 32 :5= 11`6 or` "C:R:S734=32 =116; each year; on`the anmversa date of the PeTrnit, an <br />operator shall submit thh annual fee, a report anti 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: Howard McGinnis <br />Permittee Name: Yuma County <br />Address: 1310 S. Blake St. <br />Phone Number: <br />Fax Number: <br />Wray, CO 80758 <br />(970) 332 -5718 <br />(970) 332 -3429 <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 />enclose <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />MA PERMIT TERDOCUMENTS\M -AF -04 <br />ANN/I <br />F and REPORT Q EST <br />ecs ©ac <br />