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ANNUAL FEE an~REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Moffat County <br />M-1999-048 <br />Little Snake Pit #26 <br />July 22, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Moffat <br />~~® <br /> <br />- - - =According to~C.R:S -34-32:5=1-16 or-C.R.S-34=32-1=16,-each yeaz,-on-the anmiversary-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 yeaz, the dates for the <br />beginning of active operations, and the date acfive operations ceased for the year, if any. <br />Please attach your revised written annual report and annual reuort man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's man 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 pernrittee 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) 824-0356 <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. See attached. <br />~~.~ <br />Signature o orporate Officer, Owner, or Designee <br />Billy E, ack, Director <br />Date <br />M1PERMI'PMA51'ERD000MEN7NN-AF-04 <br />-- 'JUN 29 pO pl <br />Division of ReGamation, <br />/ Mining and Safety <br />