2004-05-10_REPORT - M1978085

• Permit No: M1978085
• IBM Index Class Name: Report
• Doc Date: 5/10/2004
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNTTAT, FF.F, and RF,PORT RF, TTF'ST RECEIVED
PERMITTEE NAME: Moffat County MAY 10 2004
PERMIT NO.: M-1978-085 Division of Minerals & Geolo(IY
OPERATION NAME: Smith Pit No 20
ANNIVERSARY DATE: May 25, 2004
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date}
COUN'T'Y: 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
_ - _ ~andseclamation_accomplished_to date_and_during_the~receding~ear, new disturbances that are anficipated 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 ynnr revised written annnal rennrt and annual re~}n~ to this fnrm_ 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: Billy E. Mack
Permittee Name: Moffat County
Address: P.O. Box 667
Craig, CO 81626
Phone Number: [phone]
Fax Number: [phone]
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.
STnnOCKPILE REDUCTION ONLY - NO MAP NECESSARY
Signature orporate Officer, Owner, or Designee
LI -:~6 "o k
Date
M: WERMITVNASTERD000MENTS~IvI-AF-04