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_ ~~~~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Williams Fork Mining Company <br />M-1984-168 <br />Williams Fork Pit <br />October 25, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Moffat <br />~ti1 2 3 2003 <br />~_'ci of P.4inerals & .~ ~eolr•~~ <br />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 <br />_ shall submit the annual fee, a report and map showing the extent of current disturbances to affected land. <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual red ort and anm~al renort main to this form. Please note that an <br />adequately labeled map that clearly 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: Forrest V. Luke <br />Permittee Name: Williams Fork Mining Company <br />Address: P.O. Box 187 <br />Craig, CO 81626 <br />Phone Number: (970) 826-6140 <br />Fax Number: (970) 824-6136 <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 enclosed. <br />~9sz-~ ~ _ _~,,...c ~. <br />S gna~Corporate Officer, Owner, or Destgnee <br />aG i o8~~ ,7O ..Z~3 <br />Date <br />M:IPERM ITMASTERDOCUMENTSIM-AF-0I <br />