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`' - b <br />1 .. ~{r <br />~ {' <br />~~ ~ ~P ~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE,: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />/~ <br />Moffat County <br />M-1978-007 <br />Big Burn Pit No 17 <br />February 23, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Moffat <br />~~ ~ ~,~.~ <br />FEB 19 2008 r/ <br />Division oI tCec~~,~nation,~ <br />llAining ar~ci Safety <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 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 your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and inclucl'es the above elements may since for a written report. <br />Division records indiicate 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 />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-3211 <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. <br />~ ~~ ~ <br />Signature Q orporate Officer, Owner, or Designee <br />Date <br />M:~PERMITIMASTERDOCUMIiNTSU~I-AF-04 <br />