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ofeJc <br />V ANNT1Ai. FF.F. and RF,Pt7RT RF.OiiF,ST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Moffat Couuty <br />M-1993-023 <br />Cross Mountain Pit 1 <br />July 1, 2006 <br />RECE9~JE® <br />~~uN z s zoos <br />Uiuision of Minerals end OeafB®Y <br />$688.00 (Due on or before your anniversary date) <br />Moffat <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 <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 [hat will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach yrorr revised written annnal repo and ann .al re nrn t man 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 pet7nittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy E. Mack <br />Permittee Name: <br />Address: <br />Moffat County <br />P.O. Box 667 <br />Craig CO 81626 <br />Phone Number: - (970) 824=321 l - <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 aze <br />enclosed. <br />Stockpile Reduction Only - No Map Required <br />`~ ~P.~ ~ ~~t~ <br />Signature o~C rporate Officer, Owner, or Designee <br />-/S -Db <br />Date <br />/~ <br />M:IPERMITMASTERDOCUMENTSNI-AF-04 <br />