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~~s <br />~~ <br />~~ -~ ~ - <br />_- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Moffat County <br />M-1998-003 <br />Raftopoulos Pit #1 <br />April 28, 2004 <br />APR 05 2004 <br />Division of Minerals & DeoloBY <br />$688.00 (Due on or before your anniversary date) <br />Moffat <br />According to C.R.S. 34-32.5-]Ib or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />--operator-slurs]-subeuit-the-annual-feej-a-report and~xap-showing-the-extent-of-surre3it-dishzrbances-to-affected- - <br />]and, 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 attac~ nur revised written annual repnrt and annual renrnrt maw to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 E. Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Craig, CO 81626 <br />Phone Number: <br />Fax Number: <br />(970) 824-3211 <br />(970)824-0356 <br />If you have additional comments andJor 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 />STOCKPILE REDUCTION ONLY - P10 MAP NECESSARY <br />p~.~ ~ ~. <br />Signatur Corporate Officer, Owner, or Designee <br />March 5, 2D04 <br />Date <br />M:U'ERM71Vv7ASTEAD000MENTSV~f-AF-04 <br />