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!1 F ~ ~ t^7" <br /> ANNiiAi. FF,F, andRQF,PnRT RF,OiTF.ST <br />0 N~-tA'l <br />PERMITTEE NAME: offal County <br />M <br /> / <br />PERMIT NO.: A4I-1998-047 <br />OPERATION NAME: Mantle Pit #3 <br />ANNNERSARY DATE: September 9, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />~-Z9 vs <br />~f5 <br />r, ; DMA ~ <br />7~cc6rZTining-Fo~R:5~4=32:S-i7-S-or'e:R:S-34=32=t1b; each year,-on-the ~anriiversary-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 ym~r revised written annual report and annnal report m to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br /> Craig, CO 81626 <br />Phone Number: (970) 823-3211 <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. Stock pile reduction only, flo map required. <br />Signature~Corporate Officer, Owner, or Designee <br />~~ Id-ps <br />Date <br />M:~PERMITVNASTERDOCUMEMSUI-AF-04 <br />